Methods of modulating immunity

ABSTRACT

The invention provides novel methods of administering anti-CD3 antibodies, e.g., via oral or mucosal delivery. The invention also provides methods of treating, preventing, or delaying the onset of autoimmune disorders by oral or mucosal administration of anti-CD3 antibodies. Finally, the invention provides compositions including anti-CD3 antibodies, suitable for oral or mucosal administration.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No.12/982,390, filed Dec. 30, 2010, which is a continuation application ofU.S. patent application Ser. No. 10/987,380, filed Nov. 12, 2004, nowU.S. Pat. No. 7,883,703, issued Feb. 8, 2011, which claims the benefitunder 35 USC §119(e) of U.S. Provisional Patent Application Ser. No.60/520,148, filed on Nov. 14, 2003, and 60/567,741, filed on May 3,2004. The entire contents of the foregoing are hereby incorporated byreference.

FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

This invention was made with Government support under Grants Nos.NS-38037-01 and AI-435801, awarded by the National Institutes of Health.The Government has certain rights in the invention.

TECHNICAL FIELD

Described herein are methods for the treatment of autoimmune diseasesand preventing allograft rejection, particularly the treatment ofautoimmune diseases via oral or mucosal administration of antibodiesthat leads to stimulation of the mucosal immune system, e.g., anti-CD3antibodies.

BACKGROUND

Immunotherapy strategies that involve antibody-induced signaling throughantigen-specific T-cell receptors (TCR) have been shown to ameliorateautoimmune disease, probably by regulating the immune response toself-antigens. Parenterally administered anti-CD3 monoclonal antibody(mAb) therapy in particular has been shown to be efficacious inpreventing and reversing the onset of diabetes in NOD mice (Chatenoud etal., J. Immunol. 158:2947-2954 (1997); Belghith et al., Nat. Med.9:1202-1208 (2003)) and in treating subjects with Type I diabetes(Herold et al., N. Engl. J. Med. 346(22)1692-1698 (2002), and to reverseexperimental allergic encephalomyelitis (EAE) in Lewis rats with apreferential suppressive effect on T-helper type 1 (Th1) cells, whichparticipate in cell-mediated immunity (Tran et al., Intl. Immunol.13(9):1109-1120 (2001)). The FDA has approved Orthoclone OKT® 3(muromonab-CD3; Ortho Biotech Products, Bridgewater, N.J.), a murineanti-CD3 antibody, for intravenous injection for the treatment of graftrejection after transplantation (Chatenoud, Nat. Rev. Immunol. 3:123-132(2003)).

SUMMARY

The present invention is based in part on the discovery that oraladministration of anti-CD3 monoclonal antibody is efficacious intreating and preventing autoimmune disease. As described herein, theoral administration of anti-CD3 antibody suppresses experimentalallergic encephalomyelitis (EAE, an animal model of multiple sclerosis(MS)), delays allograft rejection in a dose-dependent fashion, reducesthe severity of arthritis, and prevents the onset of diabetes in the NODmouse. Thus, the invention provides novel methods of administeringanti-CD3 antibodies, e.g., via oral or mucosal delivery. The inventionalso provides methods of treating or preventing autoimmune disorders,e.g., a cell-mediated or antibody-mediated autoimmune diseases, and ofpreventing allograft rejection, by oral or mucosal administration ofanti-CD3 antibodies, e.g., whole antibodies or active fragments thereof(e.g., F(ab′)₂). Further, the invention provides compositions thatcontain anti-CD3 antibodies and are suitable for oral or mucosaladministration.

In one aspect, the invention provides methods of treating or preventingan autoimmune disease, or preventing allograft rejection, in a subjectby administering to the subject an anti-CD3 antibody or active fragmentthereof (e.g., F(ab′)₂). The antibody can be administered orally ormucosally, e.g., via pulmonary, buccal, nasal, intranasal, sublingual,rectal, or vaginal administration. Autoimmune diseases that can betreated in this manner include multiple sclerosis, type I diabetes,graft-versus-host disease, rheumatoid arthritis, psoriasis, inflammatorybowel disease, uveitis, and thyroiditis. In addition, a number ofautoimmune diseases that may be treated using the methods describedherein are described in Rose and Mackay, The Autoimmune Diseases(Academic Press, San Diego, Calif. 1998).

In another aspect, the invention provides methods for preventingallograft rejection in a subject. The methods include administering tothe subject an anti-CD3 antibody, wherein the administering is oral ormucosal, e.g., pulmonary, buccal, nasal, intranasal, sublingual, rectal,or vaginal. In some embodiments, the anti-CD3 antibody is administeredto the subject before, during, and/or after transplanting a cell, tissueor organ to the subject. In some embodiments, the transplant comprisesall or part of a pancreatic islet, liver, kidney, heart, lung, skin,muscle, neuronal tissue, stomach, and intestines.

In another aspect, the invention provides pharmaceutical compositionssuitable for oral or mucosal administration including an anti-CD3antibody. In some embodiments, the pharmaceutical composition issuitable for pulmonary, buccal, nasal, intranasal, sublingual, rectal,or vaginal administration. In some embodiments, the anti-CD3 antibody isselected from the group consisting of a murine monoclonal antibody, ahumanized antibody, a human antibody, and a chimeric antibody. In someembodiments, the composition suitable for oral administration is in aform selected from a liquid oral dosage form and a solid oral dosageform, e.g., selected from the group consisting of tablets, capsules,caplets, powders, pellets, granules, powder in a sachet, enteric coatedtablets, enteric coated beads, encapsulated powders, encapsulatedpellets, encapsulated granules, and enteric coated soft gel capsules. Insome embodiments, the oral dosage form is a controlled release oralformulation.

In some embodiments, the pharmaceutical compositions further compriseexcipients and/or carriers. In some embodiments, the pharmaceuticalcompositions further comprise additional active ingredients.

In an additional aspect, the invention provides methods of providing ananti-CD3 antibody to a subject. The methods can include administering tothe subject an oral dosage form suitable to deliver a dosage of ananti-CD3 antibody via the gastrointestinal tract, which, upon oraladministration, leads to stimulation of the mucosal immune system. Inanother embodiment, the methods include administering to the subject amucosal dosage form suitable to deliver a dosage of an anti-CD3 antibodyvia a mucous membrane, which, upon mucosal administration, leads tostimulation of the mucosal immune system.

In a further aspect, the invention provides methods of providing ananti-CD3 antibody to a subject. The methods include administering to thesubject an oral dosage form suitable to deliver a dosage of an anti-CD3antibody via the gastrointestinal tract, which, upon oraladministration, leads to depletion of CD3+ cells in serum to less thanabout 25 cells/mm³. Alternatively, the methods can include administeringto the subject a mucosal dosage form suitable to deliver a dosage of ananti-CD3 antibody via a mucous membrane, which, upon mucosaladministration, leads to depletion of CD3+ cells in serum to less thanabout 25 cells/mm³.

The invention provides several advantages. First, oral or mucosaladministration is easier and is generally preferred over parenteraladministration (e.g., intravenous or by injection) by the majority ofsubjects, due to the lack of needles. Second, oral or mucosaladministration facilitates chronic administration of the antibody.Third, oral or mucosal administration can avoid or reduce the negativeside effects associated with parenteral administration, includinginjection site pain. Other advantages include reduced costs, sincehighly trained personnel are not required for oral or mucosaladministration, and fewer safety concerns. In some circumstances orallyor mucosally administered anti-CD3 antibodies induce tolerance at alower dosage than parenterally administered anti-CD3 antibodies.Moreover, oral or mucosal antibodies can be effective when administeredbefore development of the disease and when given at the peak of thedisease, while parenterally administered antibodies are commonlybelieved to be effective only after onset of the disease (Chatenoud etal., J. Immunol. 158: 2947-2954 (1997); Tran et al., Int. Immunol. 13:1109-1120 (2001)). The gut and mucosal immune system is a uniqueenvironment that preferentially induces tolerance and regulatory T cells(Faria and Weiner, Adv. Immunol. 73:153-264 (1999)). Finally, oral ormucosal tolerance is systemic tolerance; for example, although theinduction of oral tolerance occurs in the gut, peripheral tolerance alsoresults (Faria and Weiner, Adv. Immunol. 73:153-264 (1999); Mowat, Nat.Rev. Immunol. 3(4):331-41 (2003)).

In some embodiments, in place of or in addition to the administration ofan anti-CD3 antibody, the methods include the administration of one ormore of a) antibodies against co-stimulatory molecules known to beinvolved in immune regulation such as CD2, ICOS, CD28, CTLA-4, and PD-1or their ligands; b) antibodies against molecules associated with NK-Tcells such as CD94, NK G2; c) antibodies against MHC molecules or theirrecognition structures such as CD4 and CD8; d) T cell differentiationmolecules as TIM molecules; and/or e) any antibodies or combinationthereof that either activate or promote tolerance.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the present invention, suitable methods andmaterials are described below. All publications, patent applications,patents, and other references mentioned herein are incorporated byreference in their entirety. In case of conflict, the presentspecification, including definitions, will control. In addition, thematerials, methods, and examples are illustrative only and not intendedto be limiting.

Other features and advantages of the invention will be apparent from thefollowing detailed description, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is a line graph illustrating the course of EAE in SJL miceimmunized with PLP (139-151) peptide and fed 5, 50, or 500:g anti-CD3antibody.

FIG. 2 is a line graph illustrating proliferation of spleen cellsisolated from SJL mice fed 5, 50, or 500:g anti-CD3 antibody andimmunized with PLP peptide (139-151) in response to stimulation with thePLP peptide.

FIG. 3 is a bar graph illustrating the proliferation of spleen cellsisolated from SJL mice fed 5, 50, or 500:g anti-CD3 antibody andimmunized with PLP peptide (139-151), in response to stimulation withthe PLP peptide.

FIG. 4 is a bar graph illustrating the proportion of CD4+/CD25+ T cellsin mesenteric lymph nodes (MLN) isolated from SJL mice fed 5:g anti-CD3or isotype-matched control.

FIGS. 5A and 5B are bar graphs illustrating the proliferation of T cellsin spleen (5A) and MLN (5B) isolated from SJL mice fed 5:g anti-CD3 orisotype-matched control.

FIG. 6 is a line graph illustrating the course of EAE in PLP peptide(48-70)-immunized NOD mice fed 0.5, 5, or 50:g anti-CD3 antibody.

FIG. 7 is a line graph illustrating the proliferation of spleen cellsisolated from NOD mice fed 0.5, 5, or 50:g anti-CD3 antibody, or 5:gisotype-matched control, and immunized with PLP peptide (48-70), inresponse to stimulation with the PLP peptide in vitro.

FIG. 8 is a bar graph illustrating the proliferation of spleen cellsisolated from NOD mice fed 0.5, 5, or 50:g anti-CD3 antibody, or 5:gisotype-matched control, and immunized with PLP peptide (48-70), inresponse to stimulation with anti-CD3 antibody.

FIG. 9 is a bar graph illustrating the production of IL-10 in spleencells isolated from NOD mice fed 0.5, 5, or 50:g anti-CD3 antibody, andimmunized with PLP peptide (48-70), in response to stimulation withanti-CD3 antibody.

FIGS. 10A and 10B are bar graphs illustrating levels of IL-10 (10A) andTGF-β (10B) secreted by spleen cells isolated from OVA transgenic (Tg)mice fed 50, 200, or 500:g anti-CD3 antibody, in response to in vitrostimulation with OVA.

FIG. 11 is a line graph illustrating the proliferation of spleen cellsisolated from OVA Tg mice fed 50, 200, or 500:g anti-CD3 antibody, inresponse to stimulation with OVA.

FIG. 12 is a line graph illustrating the course of EAE in MOG-immunizedNOD mice fed 0.5, 5, or 50:g anti-CD3 antibody.

FIG. 13A is a bar graph illustrating the proliferation of spleen cellsstimulated in vitro with anti-CD3 2:g/ml.

FIG. 13B is a bar graph illustrating the proliferation of PLN cellsstimulated with 100:g/ml PLP.

FIG. 14 is a bar graph illustrating the secretion of IL-10 from PLNcells after stimulation with anti-CD3 antibody.

FIGS. 15A and 15B are bar graphs illustrating the secretion of IL-2(15A) and IL-10 (15B) from spleen cells isolated from mice fed 0.5, 5,or 50:g anti-CD3 antibody.

FIGS. 16A and 16B are line graphs illustrating the effect on theclinical course of EAE of injection with cells isolated from the spleen(16A) or MLN (16B) of mice fed with anti-CD3 antibody.

FIGS. 17A, 17B, and 17C are line graphs illustrating the effect on theclinical course of EAE of oral administration of 0.5:g (17A), 5:g (17B),or 50:g (17C) anti-CD3 antibody before induction of EAE or at the peakof disease.

FIG. 18 is a line graph illustrating the effect of oral administrationof 0.5:g (triangles) or 5:g (circles) anti CD-3 antibody to newborn NODmice on subsequent development of diabetes, as compared to treatmentwith insulin (squares) or 0.5:g of an isotype-matched control(diamonds).

FIG. 19 is a line graph illustrating the effect of oral and nasaladministration of an F(ab)′2 fragment on the clinical course of EAE overabout 44 days.

FIG. 20 is a line graph illustrating the effect of PBS (filled squares),isotype control (filled diamonds), or anti-CD3 antibodies (filledtriangles) on the incidence of diabetes in streptozotocin-treated miceover a period of 30 days.

FIG. 21 is a graph showing the mean blood glucose levels at day 14 inthe animals in the four groups shown in FIG. 20.

FIG. 22A is a line graph showing Maximum Arthritic Index (MAI) incontrol mice (filled squares), mice treated with isotype control F(ab′)₂(open diamonds), and mice treated with anti-CD3 F(ab′)₂ (open circles).

FIG. 22B is a line graph showing Maximum Arthritic Index (MAI) in micetreated with nasal collagen (filled diamonds), and mice treated withnasal anti-CD3 F(ab′)₂ (open diamonds).

FIG. 22C is a line graph showing Maximum Arthritic Index (MAI) in micetreated with oral isotype control F(ab′)₂ (filled squares), and micetreated with oral anti-CD3 IgG F(ab′)₂ (open circles).

FIG. 23A is a bar graph showing IL-2 secretion in latency associatedpeptide (LAP)+ and LAP− T cells in mice fed with anti-CD3 (dark graybars) or isotype control (light gray bars).

FIG. 23B is a bar graph showing IL-4 secretion in latency associatedpeptide (LAP)+ and LAP− T cells in mice fed with anti-CD3 (dark graybars) or isotype control (light gray bars).

FIG. 23C is a bar graph showing IFN-gamma secretion in latencyassociated peptide (LAP)+ and LAP− T cells in mice fed with anti-CD3(dark gray bars) or isotype control (light gray bars).

FIG. 23D is a bar graph showing IL-10 secretion in latency associatedpeptide (LAP)+ and LAP− T cells in mice fed with anti-CD3 (dark graybars) or isotype control (light gray bars).

FIG. 24 is a line graph showing levels of LAP+ T cells in mice fed withisotype control antibody (triangles) or anti-CD3 antibody (circles), atdifferent ratios of modulator to LAP+ cells.

FIG. 25 is a bar graph showing the effect on suppressive activity ofLAP+ T cells co-cultured with CD4+CD25-LAP− cells from naïve mice withor without 10 mg/ml of recombinant LAP (rLAP).

FIG. 26 is a line graph showing the effect on mean clinical EAE score oftransplantation of T cells including LAP+ cells from isotype control fedmice (filled squares) or anti-CD3 fed mice (filled triangles), versusLAP-depleted T cells from isotype control fed mice (open squares) oranti-CD3 fed mice (open triangles).

FIG. 27 is a line graph showing the effect of neutralization of TGFβ onmean clinical EAE score. Mice were fed with isotype control and injectedwith anti-TGFβ Ab (filled squares), fed with anti-CD3 and injected withanti-TGFβ Ab (open triangles), fed with isotype control Ab and injectedwith isotype control Ab (open squares), or fed with anti-CD3 andinjected with anti-isotype control Ab (filled triangles).

DETAILED DESCRIPTION

Anti-CD3 antibodies have been shown to be effective in treating a numberof autoimmune disorders, both in animal models and in humans. Forexample, anti-CD3 antibodies have been shown to reverse graft rejection,probably by blocking the function of T cells which play a major role inacute allograft rejection. Previously, anti-CD3 antibody therapy hasbeen administered parenterally (i.e., administered intravenously or byinjection), based on the prevailing wisdom that the antibodies would bedegraded, decomposed, or deactivated in the gastrointestinal tract andthus rendered useless if administered orally.

The present invention provides methods of treating autoimmune diseasesvia oral or mucosal administration of anti-CD3 antibodies andcompositions suitable for oral or mucosal administration of anti-CD3antibodies.

The usefulness of an oral formulation requires that the active agent bebioavailable. Bioavailability of orally administered drugs can beaffected by a number of factors, such as drug absorption throughout thegastrointestinal tract, stability of the drug in the gastrointestinaltract, and the first pass effect. Thus, effective oral delivery of anactive agent requires that the active agent have sufficient stability inthe stomach and intestinal lumen to pass through the intestinal wall.Many drugs, however, tend to degrade quickly in the intestinal tract orhave poor absorption in the intestinal tract so that oral administrationis not an effective method for administering the drug. Surprisingly, notonly can anti-CD3 antibodies be administered orally, but it appears thatoral administration is, in some aspects, superior to parenteraladministration.

Within the immune system, a series of anatomically distinct compartmentscan be distinguished, each specially adapted to respond to pathogenspresent in a particular set of body tissues. One compartment, theperipheral compartment, comprises the peripheral lymph nodes and spleen;this compartment responds to antigens that enter the tissues or spreadinto the blood. A second compartment, the mucosal immune system, islocated near the mucosal surfaces where most pathogens invade. Themucosal immune system has evolved antigen-specific tolerance mechanismsto avoid a deleterious immune response to food antigens and beneficial,commensal microorganisms, which live in symbiosis with their host, whilestill detecting and killing pathogenic organisms that enter through thegut. Generally speaking, the gut associated lymphoid tissue (GALT) isdifferent from lymphoid tissue elsewhere; stimulation of the GALTpreferentially induces regulatory cells. The cells from the gut lymphoidtissue secrete mainly TGF-β and IL-10, and the chance and the frequencyof stimulating regulatory cells is higher in the gut.

Immune responses induced within one compartment are largely confined tothat particular compartment. Lymphocytes are restricted to particularcompartments by their expression of homing receptors that are bound byligands, known as addressins, that are specifically expressed within thetissues of the compartment. Interestingly, tolerance induced in themucosal compartment also applies to the peripheral compartment. Forexample, the feeding of ovalbumin (a strong parenteral antigen) isfollowed by an extended period during which the administration ofovalbumin by injection, even in the presence of adjuvant, elicits noantibody response in either the peripheral compartment or the mucosalcompartment. In contrast, oral tolerance is a systemic tolerance;although the induction of oral tolerance occurs in the gut, peripheraltolerance also results.

As one theory, orally administered anti-CD3 antibodies stimulate themucosal immune system. As noted above, the gut is a unique environmentin which to induce tolerance. In comparison with parenterallyadministered antibodies, lower amounts of oral anti-CD3 antibodies areneeded to induce tolerance, and oral antibodies can be effective whenadministered before development of the disease and when given at thepeak of the disease, while parenterally administered antibodies are goodonly after onset of the disease.

Pharmaceutical compositions suitable for oral administration aretypically solid dosage forms (e.g., tablets) or liquid preparations(e.g., solutions, suspensions, or elixirs). Solid dosage forms aredesirable for ease of determining and administering dosage of activeingredient, and ease of administration, particularly administration bythe subject at home. Liquid dosage forms also allow subjects to easilytake the required dose of active ingredient; liquid preparations can beprepared as a drink, or to be administered, for example, by anaso-gastric tube.

Liquid oral pharmaceutical compositions generally require a suitablesolvent or carrier system in which to dissolve or disperse the activeagent, thus enabling the composition to be administered to a subject. Asuitable solvent system is compatible with the active agent andnon-toxic to the subject. Typically, liquid oral formulations use awater-based solvent.

The oral compositions can also optionally be formulated to reduce oravoid the degradation, decomposition, or deactivation of the activeagent by the gastrointestinal system, e.g., by gastric fluid in thestomach. For example, the compositions can optionally be formulated topass through the stomach unaltered and to dissolve in the intestines,i.e., enteric coated compositions.

One of ordinary skill in the art would readily appreciate that thepharmaceutical compositions described herein can be prepared by applyingknown pharmaceutical manufacturing procedures. Such formulations can beadministered to the subject with methods well-known in thepharmaceutical arts. Thus, the practice of the present methods willemploy, unless otherwise indicated, conventional techniques ofpharmaceutical sciences including pharmaceutical dosage form design,drug development, and pharmacology, as well as of organic chemistry,including polymer chemistry. Accordingly, these techniques are withinthe capabilities of one of ordinary skill in the art and are explainedfully in the literature (See generally, for example, Remington: TheScience and Practice of Pharmacy, Nineteenth Edition. Alfonso R. Gennaro(Ed.): Mack Publishing Co., Easton, Pa., (1995), hereinafter Remington,incorporated by reference herein in its entirety).

Anti-CD3 Antibodies

The anti-CD3 antibodies can be any antibodies specific for CD3. The term“antibody” as used herein refers to an immunoglobulin molecule orimmunologically active portion thereof, i.e., an antigen-bindingportion. Examples of immunologically active portions of immunoglobulinmolecules include F(ab) and F(ab′)₂ fragments, which retain the abilityto bind CD3. Such fragments can be obtained commercially, or usingmethods known in the art. For example F(ab)₂ fragments can be generatedby treating the antibody with an enzyme such as pepsin, a non-specificendopeptidase that normally produces one F(ab)2 fragment and numeroussmall peptides of the Fc portion. The resulting F(ab)2 fragment iscomposed of two disulfide-connected Fab units. The Fc fragment isextensively degraded and can be separated from the F(ab)2 by dialysis,gel filtration or ion exchange chromatography. F(ab) fragments can begenerated using papain, a non-specific thiol-endopeptidase that digestsIgG molecules, in the presence of a reducing agent, into three fragmentsof similar size: two Fab fragments and one Fc fragment. When Fcfragments are of interest, papain is the enzyme of choice because ityields a 50,00 Dalton Fc fragment; to isolate the F(ab) fragments, theFc fragments can be removed, e.g., by affinity purification usingprotein A/G. A number of kits are available commercially for generatingF(ab) fragments, including the ImmunoPure IgG1 Fab and F(ab′)₂Preparation Kit (Pierce Biotechnology, Rockford, Ill.). In addition,commercially available services for generating antigen-binding fragmentscan be used, e.g., Bio Express, West Lebanon, N.H.

The antibody can be a polyclonal, monoclonal, recombinant, e.g., achimeric, de-immunized or humanized, fully human, non-human, e.g.,murine, or single chain antibody. In some embodiments the antibody haseffector function and can fix complement. In some embodiments, theantibody has reduced or no ability to bind an Fc receptor. For example,the anti-CD3 antibody can be an isotype or subtype, fragment or othermutant, which does not support binding to an Fc receptor, e.g., it has amutagenized or deleted Fc receptor binding region. The antibody can becoupled to a toxin or imaging agent.

A number of anti-CD3 antibodies are known, including but not limited toOKT3 (muromonab/Orthoclone OKT3™, Ortho Biotech, Raritan, N.J.; U.S.Pat. No. 4,361,549); hOKT3(1 (Herold et al., N.E.J.M. 346(22):1692-1698(2002); HuM291 (Nuvion™, Protein Design Labs, Fremont, Calif.); gOKT3-5(Alegre et al., J. Immunol. 148(11):3461-8 (1992); 1F4 (Tanaka et al.,J. Immunol. 142:2791-2795 (1989)); G4.18 (Nicolls et al.,Transplantation 55:459-468 (1993)); 145-2C11 (Davignon et al., J.Immunol. 141(6):1848-54 (1988)); and as described in Frenken et al.,Transplantation 51(4):881-7 (1991); U.S. Pat. Nos. 6,491,9116,6,406,696, and 6,143,297).

Methods for making such antibodies are also known. A full-length CD3protein or antigenic peptide fragment of CD3 can be used as animmunogen, or can be used to identify anti-CD3 antibodies made withother immunogens, e.g., cells, membrane preparations, and the like,e.g., E rosette positive purified normal human peripheral T cells, asdescribed in U.S. Pat. Nos. 4,361,549 and 4,654,210. The anti-CD3antibody can bind an epitope on any domain or region on CD3.

Chimeric, humanized, de-immunized, or completely human antibodies aredesirable for applications which include repeated administration, e.g.,therapeutic treatment of human subjects.

Chimeric antibodies contain portions of two different antibodies,typically of two different species. Generally, such antibodies containhuman constant regions and variable regions from another species, e.g.,murine variable regions. For example, mouse/human chimeric antibodieshave been reported which exhibit binding characteristics of the parentalmouse antibody, and effector functions associated with the humanconstant region. See, e.g., Cabilly et al., U.S. Pat. No. 4,816,567;Shoemaker et al., U.S. Pat. No. 4,978,745; Beavers et al., U.S. Pat. No.4,975,369; and Boss et al., U.S. Pat. No. 4,816,397, all of which areincorporated by reference herein. Generally, these chimeric antibodiesare constructed by preparing a genomic gene library from DNA extractedfrom pre-existing murine hybridomas (Nishimura et al., Cancer Research,47:999 (1987)). The library is then screened for variable region genesfrom both heavy and light chains exhibiting the correct antibodyfragment rearrangement patterns. Alternatively, cDNA libraries areprepared from RNA extracted from the hybridomas and screened, or thevariable regions are obtained by polymerase chain reaction. The clonedvariable region genes are then ligated into an expression vectorcontaining cloned cassettes of the appropriate heavy or light chainhuman constant region gene. The chimeric genes can then be expressed ina cell line of choice, e.g., a murine myeloma line. Such chimericantibodies have been used in human therapy.

Humanized antibodies are known in the art. Typically, “humanization”results in an antibody that is less immunogenic, with complete retentionof the antigen-binding properties of the original molecule. In order toretain all the antigen-binding properties of the original antibody, thestructure of its combining-site has to be faithfully reproduced in the“humanized” version. This can potentially be achieved by transplantingthe combining site of the nonhuman antibody onto a human framework,either (a) by grafting the entire nonhuman variable domains onto humanconstant regions to generate a chimeric antibody (Morrison et al., Proc.Natl. Acad. Sci., USA 81:6801 (1984); Morrison and Oi, Adv. Immunol.44:65 (1988) (which preserves the ligand-binding properties, but whichalso retains the immunogenicity of the nonhuman variable domains); (b)by grafting only the nonhuman CDRs onto human framework and constantregions with or without retention of critical framework residues (Joneset al. Nature, 321:522 (1986); Verhoeyen et al., Science 239:1539(1988)); or (c) by transplanting the entire nonhuman variable domains(to preserve ligand-binding properties) but also “cloaking” them with ahuman-like surface through judicious replacement of exposed residues (toreduce antigenicity) (Padlan, Molec. Immunol. 28:489 (1991)).

Humanization by CDR grafting typically involves transplanting only theCDRs onto human fragment onto human framework and constant regions.Theoretically, this should substantially eliminate immunogenicity(except if allotypic or idiotypic differences exist). However, it hasbeen reported that some framework residues of the original antibody alsoneed to be preserved (Riechmann et al., Nature 332:323 (1988); Queen etal., Proc. Natl. Acad. Sci. USA 86:10,029 (1989)). The frameworkresidues which need to be preserved can be identified by computermodeling. Alternatively, critical framework residues may potentially beidentified by comparing known antibody combining site structures(Padlan, Molec. Immun. 31(3):169-217 (1994)). The invention alsoincludes partially humanized antibodies, in which the 6 CDRs of theheavy and light chains and a limited number of structural amino acids ofthe murine monoclonal antibody are grafted by recombinant technology tothe CDR-depleted human IgG scaffold (Jones et al., Nature 321:522-525(1986)).

Deimmunized antibodies are made by replacing immunogenic epitopes in themurine variable domains with benign amino acid sequences, resulting in adeimmunized variable domain. The deimmunized variable domains are linkedgenetically to human IgG constant domains to yield a deimmunizedantibody (Biovation, Aberdeen, Scotland).

The anti-CD3 antibody can also be a single chain antibody. Asingle-chain antibody (scFV) can be engineered (see, for example,Colcher et al., Ann. N. Y. Acad. Sci. 880:263-80 (1999); and Reiter,Clin. Cancer Res. 2:245-52 (1996)). The single chain antibody can bedimerized or multimerized to generate multivalent antibodies havingspecificities for different epitopes of the same target CD3 protein. Insome embodiments, the antibody is monovalent, e.g., as described in Abbset al., Ther. Immunol. 1(6):325-31 (1994), incorporated herein byreference.

Pharmaceutical Compositions

The anti-CD3 antibodies described herein can be incorporated into apharmaceutical composition suitable for oral or mucosal administration,e.g., by ingestion, inhalation, or absorption, e.g., via nasal,intranasal, pulmonary, buccal, sublingual, rectal, or vaginaladministration. Such compositions can include an inert diluent or anedible carrier. For the purpose of oral therapeutic administration, theactive compound (e.g., an anti-CD3 antibody) can be incorporated withexcipients and used in solid or liquid (including gel) form. Oralanti-CD3 antibody compositions can also be prepared using an excipient.Pharmaceutically compatible binding agents, and/or adjuvant materialscan be included as part of the composition. Oral dosage forms comprisinganti-CD3 antibody are provided, wherein the dosage forms, upon oraladministration, provide a therapeutically effective blood level ofanti-CD3 antibody to a subject. Also provided are mucosal dosage formscomprising anti-CD3 antibody wherein the dosage forms, upon mucosaladministration, provide a therapeutically effective blood level ofanti-CD3 antibody to a subject. For the purpose of mucosal therapeuticadministration, the active compound (e.g., an anti-CD3 antibody) can beincorporated with excipients or carriers suitable for administration byinhalation or absorption, e.g., via nasal sprays or drops, or rectal orvaginal suppositories.

Solid oral dosage forms include, but are not limited to, tablets (e.g.,chewable tablets), capsules, caplets, powders, pellets, granules, powderin a sachet, enteric coated tablets, enteric coated beads, and entericcoated soft gel capsules. Also included are multi-layered tablets,wherein different layers can contain different drugs. Solid dosage formsalso include powders, pellets and granules that are encapsulated. Thepowders, pellets, and granules can be coated, e.g., with a suitablepolymer or a conventional coating material to achieve, for example,greater stability in the gastrointestinal tract, or to achieve a desiredrate of release. In addition, a capsule comprising the powder, pelletsor granules can be further coated. A tablet or caplet can be scored tofacilitate division for ease in adjusting dosage as needed. The dosageforms of the present invention can be unit dosage forms wherein thedosage form is intended to deliver one therapeutic dose peradministration, e.g., one tablet is equal to one dose. Such dosage formscan be prepared by methods of pharmacy well known to those skilled inthe art (see Remington's Pharmaceutical Sciences, 18th ed., MackPublishing, Easton Pa. (1990)).

Typical oral dosage forms can be prepared by combining the activeingredients in an intimate admixture with at least one excipientaccording to conventional pharmaceutical compounding techniques.Excipients can take a wide variety of forms depending on the form ofpreparation desired for administration. For example, excipients suitablefor use in solid oral dosage forms (e.g., powders, tablets, capsules,and caplets) include, but are not limited to, starches, sugars,micro-crystalline cellulose, diluents, granulating agents, lubricants,binders, and disintegrating agents. Examples of excipients suitable foruse in oral liquid dosage forms include, but are not limited to, water,glycols, oils, alcohols, flavoring agents, preservatives, and coloringagents.

Tablets and capsules represent convenient pharmaceutical compositionsand oral dosage forms, in which case solid excipients are employed. Ifdesired, tablets can be coated by standard aqueous or non-aqueoustechniques. Such dosage forms can be prepared by any of the methods ofpharmacy. In general, pharmaceutical compositions and dosage forms areprepared by uniformly and intimately admixing the active ingredientswith liquid carriers, finely divided solid carriers, or both, and thenshaping the product into the desired presentation if necessary.

As one example, a tablet can be prepared by compression or by molding.Compressed tablets can be prepared, e.g., by compressing, in a suitablemachine, the active ingredients (e.g., an anti-CD3 antibody) in afree-flowing form such as powder or granules, optionally mixed with anexcipient. Molded tablets can be made, e.g., by molding, in a suitablemachine, a mixture of the powdered anti-CD3 antibody compound moistened,e.g., with an inert liquid diluent.

Excipients that can be used in oral dosage forms of the inventioninclude, but are not limited to, binders, fillers, disintegrants, andlubricants. Binders suitable for use in pharmaceutical compositions anddosage forms include, but are not limited to, corn starch, potatostarch, or other starches, gum tragacanth or gelatin, natural andsynthetic gums such as acacia, sodium alginate, alginic acid, otheralginates, powdered tragacanth, guar gum, cellulose and its derivatives(e.g., ethyl cellulose, cellulose acetate, carboxymethyl cellulosecalcium, sodium carboxymethyl cellulose), polyvinyl pyrrolidinones,methyl cellulose, pre-gelatinized starch, hydroxypropyl methylcellulose, (e.g., Nos. 2208, 2906, 2910), microcrystalline cellulose,and mixtures thereof.

Suitable forms of microcrystalline cellulose include, but are notlimited to, the materials sold as AVICEL® PH-101, AVICEL® PH-103 AVICEL®RC-581, AVICEL® PH-105 (available from FMC Corporation, American ViscoseDivision, Avicel Sales, Marcus Hook, Pa.), and mixtures thereof. Aspecific binder is a mixture of microcrystalline cellulose and sodiumcarboxymethyl cellulose sold as AVICEL® RC-581. Suitable anhydrous orlow moisture excipients or additives include AVICEL® PH-103 and Starch1500® LM.

Examples of fillers suitable for use in the pharmaceutical compositionsand dosage forms disclosed herein include, but are not limited to, talc,calcium carbonate (e.g., granules or powder), microcrystallinecellulose, powdered cellulose, dextrates, kaolin, mannitol, silicicacid, sorbitol, starch, pre-gelatinized starch, and mixtures thereof.The binder or filler in pharmaceutical compositions and dosage forms ofthe invention is typically present in from about 50 to about 99 weightpercent of the pharmaceutical composition or dosage form.

Disintegrants can be used in the pharmaceutical compositions and oral ormucosal dosage forms of the invention to provide tablets thatdisintegrate when exposed to an aqueous environment. Tablets containingtoo much disintegrant might disintegrate in storage, while thosecontaining too little might not disintegrate at a desired rate or underdesired conditions. Thus, a sufficient amount of disintegrant that isneither too much nor too little to detrimentally alter the release ofthe active ingredients should be used to form the pharmaceuticalcompositions and solid oral dosage forms described herein. The amount ofdisintegrant used varies based upon the type of formulation, and isreadily discernible to those of ordinary skill in the art. Typically,pharmaceutical compositions and dosage forms comprise from about 0.5 toabout 15 weight percent of disintegrant, preferably from about 1 toabout 5 weight percent of disintegrant.

Disintegrants that can be used in pharmaceutical compositions and oralor mucosal dosage forms of the invention include, but are not limitedto, agar-agar, alginic acid, calcium carbonate, Primogel,microcrystalline cellulose, croscarmellose sodium, crospovidone,polacrilin potassium, sodium starch glycolate, corn, potato or tapiocastarch, other starches, pre-gelatinized starch, other starches, clays,other algins, other celluloses, gums, and mixtures thereof.

Lubricants that can be used in pharmaceutical compositions and dosageforms of the invention include, but are not limited to, calciumstearate, magnesium stearate or Sterotes, mineral oil, light mineraloil, glycerin, sorbitol, mannitol, polyethylene glycol, other glycols,stearic acid, sodium lauryl sulfate, talc, hydrogenated vegetable oil(e.g., peanut oil, cottonseed oil, sunflower oil, sesame oil, olive oil,corn oil, and soybean oil), zinc stearate, ethyl oleate, ethyl laureate,agar, and mixtures thereof. Additional lubricants include, for example,a syloid silica gel (AEROSIL® 200, manufactured by W. R. Grace Co. ofBaltimore, Md.), a coagulated aerosol of synthetic silica (marketed byDegussa Co. of Plano, Tex.), CAB-O-SIL® (a pyrogenic silicon dioxideproduct sold by Cabot Co. of Boston, Mass.), and mixtures thereof. Ifused at all, lubricants are typically used in an amount of less thanabout 1 weight percent of the pharmaceutical compositions or dosageforms into which they are incorporated. A glidant such as colloidalsilicon dioxide can also be used.

The pharmaceutical compositions and oral or mucosal dosage forms canfurther comprise one or more compounds that reduce the rate by which anactive ingredient will decompose. Thus the oral dosage forms describedherein can be processed into an immediate release or a sustained releasedosage form. Immediate release dosage forms may release the anti-CD3antibody in a fairly short time, for example, within a few minutes towithin a few hours. Sustained release dosage forms may release theanti-CD3 antibody over a period of several hours, for example, up to 24hours or longer, if desired. In either case, the delivery can becontrolled to be substantially at a certain predetermined rate over theperiod of delivery. In some embodiments, the solid oral dosage forms canbe coated with a polymeric or other known coating material(s) toachieve, for example, greater stability on the shelf or in thegastrointestinal tract, or to achieve control over drug release. Suchcoating techniques and materials used therein are well-known in the art.Such compounds, which are referred to herein as “stabilizers,” include,but are not limited to, antioxidants such as ascorbic acid and saltbuffers. For example, cellulose acetate phthalate, polyvinyl acetatephthalate, hydroxypropylmethyl cellulose phthalate, methacrylicacid-methacrylic acid ester copolymers, cellulose acetate trimellitate,carboxymethylethyl cellulose, and hydroxypropylmethyl cellulose acetatesuccinate, among others, can be used to achieve enteric coating.Mixtures of waxes, shellac, zein, ethyl cellulose, acrylic resins,cellulose acetate, silicone elastomers can be used to achieve sustainedrelease coating. See, for example, Remington, supra, Chapter 93, forother types of coatings, techniques and equipment.

Liquids for oral or mucosal administration represent another convenientdosage form, in which case a solvent can be employed. In someembodiments, the solvent is a buffered liquid such as phosphate bufferedsaline (PBS). Liquid oral dosage forms can be prepared by combining theactive ingredient in a suitable solvent to form a solution, suspension,syrup, or elixir of the active ingredient in the liquid. The solutions,suspensions, syrups, and elixirs may optionally comprise other additivesincluding, but not limited to, glycerin, sorbitol, propylene glycol,sugars or other sweeteners, flavoring agents, and stabilizers. Flavoringagents can include, but are not limited to peppermint, methylsalicylate, or orange flavoring. Sweeteners can include sugars,aspartame, saccharin, sodium cyclamate and xylitol.

In order to reduce the degree of inactivation of orally administeredanti-CD3 antibody in the stomach of the treated subject, an antiacid canbe administered simultaneously with the immunoglobulin, whichneutralizes the otherwise acidic character of the gut. Thus in someembodiments, the anti-CD3 antibody is administered orally with anantacid, e.g., aluminum hydroxide or magnesium hydroxide such as MAALOX®antacid or MYLANTA® antacid, or an H2 blocker, such as cimetidine orranitidine. One of skill in the art will appreciate that the dose ofantiacid administered in conjunction with an anti-CD3 antibody dependson the particular antacid used. When the antacid is MYLANTA® antacid inliquid form, between 15 ml and 30 ml can be administered, e.g., about 15ml. When the cimetidine H2 blocker is used, between about 400 and 800 mgper day can be used.

The kits described herein can include an oral anti-CD3 antibodycomposition as an already prepared liquid oral dosage form ready foradministration or, alternatively, can include an anti-CD3 antibodycomposition as a solid pharmaceutical composition that can bereconstituted with a solvent to provide a liquid oral dosage form. Whenthe kit includes an anti-CD3 antibody composition as a solidpharmaceutical composition that can be reconstituted with a solvent toprovide a liquid dosage form (e.g., for oral or nasal administration),the kit may optionally include a reconstituting solvent. In this case,the constituting or reconstituting solvent is combined with the activeingredient to provide a liquid oral dosage form of the activeingredient. Typically, the active ingredient is soluble in the solventand forms a solution. The solvent can be, e.g., water, a non-aqueousliquid, or a combination of a non-aqueous component and an aqueouscomponent. Suitable non-aqueous components include, but are not limitedto oils; alcohols, such as ethanol; glycerin; and glycols, such aspolyethylene glycol and propylene glycol. In some embodiments, thesolvent is phosphate buffered saline (PBS).

For administration by inhalation, the mucosal anti-CD3 antibodycompounds can be delivered in the form of an aerosol spray frompressured container or dispenser which contains a suitable propellant,e.g., a gas such as carbon dioxide, or a nebulizer. Such methods includethose described in U.S. Pat. No. 6,468,798.

Systemic administration can also be by transmucosal means. Fortransmucosal administration, penetrants appropriate to the barrier to bepermeated are used in the formulation. Such penetrants are generallyknown in the art, and include, for example, for transmucosaladministration, detergents, bile salts, and fusidic acid derivatives.Transmucosal administration can be accomplished through the use of nasaldrops or sprays, or rectal or vaginal suppositories.

The anti-CD3 antibody compounds can also be prepared in the form ofsuppositories (e.g., with conventional suppository bases such as cocoabutter and other glycerides) or retention enemas for rectal delivery.

In one embodiment, the oral or mucosal anti-CD3 antibody compositionsare prepared with carriers that will protect the anti-CD3 antibodyagainst rapid elimination from the body, such as a controlled releaseformulation, including implants and microencapsulated delivery systems.Biodegradable, biocompatible polymers can be used, such as ethylenevinyl acetate, polyanhydrides, polyglycolic acid, collagen,polyorthoesters, and polylactic acid. Such formulations can be preparedusing standard techniques. The materials can also be obtainedcommercially from Alza Corporation and Nova Pharmaceuticals, Inc.Liposomal suspensions (including liposomes targeted to infected cellswith monoclonal antibodies to viral antigens) can also be used aspharmaceutically acceptable carriers. These can be prepared according tomethods known to those skilled in the art, for example, as described inU.S. Pat. No. 4,522,811.

Dosage, toxicity and therapeutic efficacy of such anti-CD3 antibodycompositions can be determined by standard pharmaceutical procedures incell cultures (e.g., of cells taken from an animal after mucosaladministration of an anti-CD3 antibody) or experimental animals, e.g.,for determining the LD₅₀ (the dose lethal to 50% of the population) andthe ED₅₀ (the dose therapeutically effective in 50% of the population).The dose ratio between toxic and therapeutic effects is the therapeuticindex and it can be expressed as the ratio LD₅₀/ED₅₀. Compositions whichexhibit high therapeutic indices are preferred. While anti-CD3 antibodycompositions that exhibit toxic side effects may be used, care should betaken to design a delivery system that targets such compounds to thesite of affected tissue in order to minimize potential damage and,thereby, reduce side effects.

The data obtained from the cell cultures (e.g., of cells taken from ananimal after mucosal administration of an anti-CD3 antibody) and animalstudies can be used in formulating a range of dosage for use in humans.The dosage of anti-CD3 antibody compositions lies preferably within arange of circulating concentrations that include the ED₅₀ with little orno toxicity. The dosage may vary within this range depending upon thedosage form employed and the route of administration utilized. For anyoral or mucosal anti-CD3 antibody compositions used in the methodsdescribed herein, the therapeutically effective dose can be estimatedinitially from assays of cell cultures (e.g., of cells taken from ananimal after mucosal administration of an anti-CD3 antibody). A dose maybe formulated in animal models to achieve a desired circulating plasmaconcentration of IL-10 or TGF-β, or of regulatory cells, in the rangethat includes the IC₅₀ (i.e., the concentration of the test compoundwhich achieves a half-maximal inhibition of symptoms) as determined incell culture. Such information can be used to more accurately determineuseful doses in humans. Levels of IL-10 or TGF-β in plasma can bemeasured by methods known in the art, for example, by ELISA. Levels ofregulatory cells can be measured by methods known in the art, forexample, by flow cytometry-based methods.

As defined herein, a therapeutically effective amount of an anti-CD3antibody (i.e., an effective dosage) depends on the antibody selected,the mode of delivery, and the condition to be treated. For instance,single dose amounts in the range of approximately 1:g/kg to 1000 μg/kgmay be administered; in some embodiments, about 5, 10, 50, 100, or500:g/kg may be administered. In some embodiments, e.g., pediatricsubjects, about 1 to 100:g/kg, e.g., about 25 or 50:g/kg, of anti-CD3antibody can be administered. The anti-CD3 antibody compositions can beadministered from one or more times per day to one or more times perweek; including once every other day. The oral or mucosal anti-CD3antibody compositions can be administered, e.g., for about 10 to 14 daysor longer. The skilled artisan will appreciate that certain factors mayinfluence the dosage and timing required to effectively treat a subject,including but not limited to the severity of the disease or disorder,previous treatments, the general health and/or age of the subject, andother diseases present. Moreover, treatment of a subject with atherapeutically effective amount of the compounds can include a singletreatment or, can include a series of treatments.

The oral or mucosal anti-CD3 antibody compositions can also include oneor more therapeutic agents useful for treating an autoimmune disorder.Such therapeutic agents can include, e.g., NSAIDs (including COX-2inhibitors); other antibodies, e.g., anti-cytokine antibodies, e.g.,antibodies to IFN-∀, IFN-(, and/or TNF-∀; gold-containing compounds;immunosuppressive drugs (such as corticosteroids, e.g., prednisolone andmethyl prednisolone; cyclophosphamide; azathioprine; mycophenolatemofetil (MMF); cyclosporin and tacrolimus; methotrexate; orcotrimoxazole); heat shock proteins (e.g., as described in U.S. Pat. No.6,007,821); and treatments for MS, e.g., β-interferons (e.g., interferonβ-1a, interferon β-1b), mitoxantrone, or glatiramer acetate.

The pharmaceutical compositions can be included in a container, pack, ordispenser together with instructions for administration.

Methods of Treatment and Prevention

The oral and mucosal anti-CD3 antibody compositions described herein canbe administered to a subject to treat or prevent disorders associatedwith an abnormal or unwanted immune response, e.g., an autoimmunedisorder, e.g., by affecting the functional properties of thecirculating CD3+ T cells (e.g., reducing their proliferative capacity)or by inducing regulatory cells. Examples of autoimmune disordersinclude, but are not limited to, Alopecia Areata, Lupus, AnkylosingSpondylitis, Meniere's Disease, Antiphospholipid Syndrome, MixedConnective Tissue Disease, Autoimmune Addison's Disease, MultipleSclerosis, Autoimmune Hemolytic Anemia, Myasthenia Gravis, AutoimmuneHepatitis, Pemphigus Vulgaris, Behcet's Disease, Pernicious Anemia,Bullous Pemphigoid, Polyarthritis Nodosa, Cardiomyopathy,Polychondritis, Celiac Sprue-Dermatitis, Polyglandular Syndromes,Chronic Fatigue Syndrome (CFIDS), Polymyalgia Rheumatica, ChronicInflammatory Demyelinating, Polymyositis and Dermatomyositis, ChronicInflammatory Polyneuropathy, Primary Agammaglobulinemia, Churg-StraussSyndrome, Primary Biliary Cirrhosis, Cicatricial Pemphigoid, Psoriasis,CREST Syndrome, Raynaud's Phenomenon, Cold Agglutinin Disease, Reiter'sSyndrome, Crohn's Disease, Rheumatic Fever, Discoid Lupus, RheumatoidArthritis, Essential Mixed, Cryoglobulinemia Sarcoidosis, Fibromyalgia,Scleroderma, Grave's Disease, Sjögren's Syndrome, Guillain-Barre,Stiff-Man Syndrome, Hashimoto's Thyroiditis, Takayasu Arteritis,Idiopathic Pulmonary Fibrosis, Temporal Arteritis/Giant Cell Arteritis,Idiopathic Thrombocytopenia Purpura (ITP), Ulcerative Colitis, IgANephropathy, Uveitis, Insulin Dependent Diabetes (Type I), Vasculitis,Lichen Planus, and Vitiligo. The oral anti-CD3 antibody compositionsdescribed herein can be administered to a subject to treat or preventdisorders associated with an abnormal or unwanted immune responseassociated with cell, tissue or organ transplantation, e.g., renal,hepatic, and cardiac transplantation, e.g., graft versus host disease(GVHD), or to prevent allograft rejection.

In some embodiments, a therapeutically effective amount of an oral ormucosal anti-CD3 antibody composition can be, e.g., the amount necessaryto reduce T cell proliferation by about at least 20%. In someembodiments, T cell proliferation is reduced by at least about 30%,about 40%, about 50%, about 60%, about 70% about 80%, or about 90% frompre-treatment levels. In addition, concentrations of IL-10 and/or TGF-β,or levels of cells secreting these cytokines, can be measured in theperipheral blood, e.g., using an enzyme-linked immunosorbent assay(ELISA) or a cell-based assay such as FACS scanning, to monitor theinduction of tolerance. In some embodiments, a therapeutically effectiveamount of an oral or mucosal anti-CD3 antibody composition is the amountnecessary increase levels of cells secreting IL-10 and/or TGF-β asmeasured in the peripheral blood by about 20% or more. In someembodiments, levels of cells secreting IL-10 and/or TGF-β as measured inthe peripheral blood are increased by at least about 60%, 70%, 80%, 90%,or 100%, e.g., doubled.

The methods of treatment or prevention typically include administeringto a subject an oral or mucosal anti-CD-3 antibody compositionsufficient to stimulate the mucosal immune system. In some embodiments,the methods include administering an oral or mucosal anti-CD3 antibodycomposition sufficient to increase IL-10 and/or TGF-β production by Tcells in the peripheral blood, e.g., regulatory T cells, e.g., by about100%, 200%, 300% or more. In some embodiments, the methods includeadministering an oral anti-CD3 antibody composition sufficient todecrease T cell proliferation in the peripheral blood, e.g., by about20%; e.g., in some embodiments, by at least about 20%, 30%, 40%, 50%,60%, 70%, 80%, 90%, or more. In some embodiments, the methods includeadministering an oral or mucosal anti-CD3 antibody compositionsufficient to increase serum concentrations of IL-10 and/or TGF-β, e.g.,measured using an enzyme-linked immunosorbent assay (ELISA), to monitorthe induction of tolerance. In some embodiments, the methods includeadministering an oral or mucosal anti-CD3 antibody compositionsufficient to increase levels of regulatory cells in the serum. In someembodiments, the methods include administering an oral or mucosalanti-CD3 composition sufficient to produce an improvement in one or moreclinical markers of disability; for example, in multiple sclerosis, suchmarkers could include gadolinium-enhancing lesions visualized by MRI, orPaty's, Fazekas' or Barkhofs MRI criteria, or McDonald's diagnosticcriteria; in diabetes, such markers could include blood or plasmaglucose levels, glucosuria, ketonuria, polyuria, polydipsia, weight losswith normal or even increased food intake, fatigue, and blurred vision.

Cytokine Release Syndrome (CRS) is not expected to be associated withorally administered anti-CD3 antibodies, but the methods can includemonitoring the subjects for signs and symptoms of Cytokine ReleaseSyndrome, particularly after the first few doses but also after atreatment hiatus with resumption of therapy; such methods areparticularly useful in determining the safety of oral or mucosaladministration of the anti-CD3 antibodies. CRS is associated witharthralgias, myalgias, fevers, chills, hypoxia, nausea, and vomiting;severe cytokine release syndrome can cause pulmonary edema andsuffocation. In some embodiments, the methods include lowering thesubject's temperature to less than about 37.8° C. (100° F.) before theadministration of any dose of the anti-CD3 antibody compositions. Insome embodiments, the methods include screening the subject for clinicalevidence of volume overload, uncontrolled hypertension, or uncompensatedheart failure. In some embodiments, the methods include notadministering the oral or mucosal anti-CD3 antibodies to subjects whohave evidence of any of, volume overload, uncontrolled hypertension, oruncompensated heart failure. In some embodiments, the methods involveevaluating the subject's pulmonary function, and not administering theanti-CD3 antibodies to subjects who do not have a clear chest X-ray. Insome embodiments, the methods include monitoring CD3+ T cell clearanceand/or plasma levels of anti-CD3 antibody, and adjusting the dosage ofthe oral or mucosal anti-CD3 compositions accordingly.

In some embodiments, the methods include administering to the subjectmethylprednisolone sodium succinate 8.0 mg/kg, e.g., intravenously,e.g., 1 to 4 hours before administration of the oral or mucosal anti-CD3antibody compositions. In some embodiments, the methods can includeadministering to the subject an anti-inflammatory agent, e.g.,acetaminophen or antihistamine, before, concomitantly with, or afteradministration of the oral or mucosal anti-CD3 compositions.

In some embodiments, the methods include evaluating and/or monitoring asubject for anti-mouse antibodies, and discontinuing administration ofthe oral or mucosal anti-CD3 antibody compositions if the subject hasanti-mouse antibody titers of greater than about 1:1000. The developmentof anti-mouse antibodies is not expected with orally or mucosallyadministered anti-CD3 antibodies.

In some embodiments, the oral or mucosal anti-CD3 antibody compositionsare administered concurrently with one or more second therapeuticmodalities, e.g., symptomatic treatment, high dose immunosuppressivetherapy and/or autologous peripheral blood stem cell transplantation(HSCT). Such methods are known in the art and can include administrationof agents useful for treating an autoimmune disorder, e.g., NSAIDs(including selective COX-2 inhibitors); other antibodies, e.g.,anti-cytokine antibodies, e.g., antibodies to IFN-∀, IFN-(, and/orTNF-∀; gold-containing compounds; heat shock proteins (e.g., asdescribed in U.S. Pat. No. 6,007,821); immunosuppressive drugs (such ascorticosteroids, e.g., prednisolone and methyl prednisolone;cyclophosphamide; azathioprine; mycophenolate mofetil (MMF); cyclosporinand tacrolimus; methotrexate; or cotrimoxazole) and therapeutic cellpreparations, e.g., subject-specific cell therapy, hematopoietic stemcell therapy. In some embodiments, the methods include administering oneor more treatments for multiple sclerosis, e.g., β-interferons (e.g.,interferon β-1a, interferon β-1b), mitoxantrone, or glatiramer acetate.In some embodiments, the methods include administering one or morenon-anti-CD3 immunosuppressive drugs (such as corticosteroids, e.g.,prednisolone and methyl prednisolone; cyclophosphamide; azathioprine;mycophenolate mofetil (MMF); cyclosporin and tacrolimus; methotrexate;or cotrimoxazole) to the subject, e.g., before, during, or afteradministration of the oral or mucosal anti-CD3 compositions.

In some embodiments, the methods include administering one or morestandard treatments for diabetes, e.g., administration of one or moreagents useful in the treatment of diabetes, e.g., insulin, sulfonylureas(e.g., meglitinides and nateglinides), biguanides, thiazolidinediones,and alpha-glucosidase inhibitors, inter alia, as well as modification ofdiet or exercise regime.

Treatment or Prevention of Multiple Sclerosis

Multiple Sclerosis (MS) is typically characterized clinically byrecurrent or chronically progressive neurologic dysfunction, caused bylesions in the CNS. Pathologically, the lesions include multiple areasof demyelination affecting the brain, optic nerves, and spinal cord. Theunderlying etiology is uncertain, but MS is widely believed to be atleast partly an autoimmune or immune-mediated disease.

Thus, the invention includes methods of treating, delaying or preventingthe onset of MS, by orally or mucosally administering an anti-CD3antibody.

Included are methods wherein a subject who has or is at risk of havingMS is orally administered anti-CD3 antibody. In one aspect, theinvention features methods of screening for subjects at risk for MS,e.g., by screening for one or more indicators of MS to evaluate if thesubject is at risk for developing MS, and orally or mucosallyadministering anti-CD3 antibody if the subject is determined to be atrisk. As susceptibility to MS is at least partly familial, subjects whohave a relative with MS can be considered at increased risk fordeveloping MS.

In some embodiments, the methods include orally or mucosallyadministering a therapeutically effective amount of anti-CD3 antibody toa subject diagnosed with MS. The diagnosis of MS is typically made onthe basis of the clinical signs and symptoms, include heat sensitivity,internuclear ophthalmoplegia, optic neuritis, and Lhermitte symptom(see, e.g., McDonald et al., Recommended Diagnostic Criteria forMultiple Sclerosis: Guidelines From the International Panel on theDiagnosis of Multiple Sclerosis. Ann. Neurol. 50:121, 2001). Atherapeutically effective amount can be an amount sufficient to preventthe onset of an acute episode or to shorten the duration of an acuteepisode, or to decrease the severity of one or more symptoms, e.g., heatsensitivity, internuclears ophthalmoplegia, optic neuritis, andLhermitte symptom. In some embodiments, a therapeutically effectiveamount is an amount sufficient to prevent the appearance of or promotethe healing of a demyelinated lesion in one or more of the brain, opticnerves, and spinal cord of the subject, e.g., as demonstrated on MRI.

In some embodiments, the oral or mucosal anti-CD3 antibody isadministered in combination with a standard treatment for MS, e.g.,administration of corticosteroid therapy, interferon beta-1b,Glatiramer, mitoxantrone, cannabis, or a combination thereof. In someembodiments, the oral anti-CD3 antibody is administered in combinationwith a treatment for one or more symptoms of MS, e.g., depression andfatigue, bladder dysfunction, spasticity, pain, ataxia, and intentiontremor; such treatments include pharmacological agents, exercise, andappropriate orthotics. Additional information on the diagnosis andtreatment of MS can be found at the National MS Society website, on theworld wide web at nationalmssociety.org, the contents of which areincorporated by reference herein.

The median time from onset of disease to disability severe enough forthe subject to require aids for ambulation is about 15 years; thus, insome embodiments the invention includes a method of delaying the onsetof disability due to MS comprising administering a therapeuticallyeffective amount of an oral anti-CD3 antibody.

Treatment of Prevention of Diabetes Mellitus

There is strong evidence for a cell-mediated autoimmune process beinginvolved in the destruction of beta cells in the majority of cases oftype 1 diabetes mellitus. Thus, the methods described herein includemethods of treating or preventing diabetes mellitus, e.g., Type I (alsosometimes referred to as insulin-dependent or juvenile-onset) diabetes.

Included are methods wherein a subject who has or is at risk of havingdiabetes mellitus is orally or mucosally administered anti-CD3 antibody.In one aspect, the invention features methods of preventing diabetes byscreening for subjects at risk for diabetes, e.g., by screening forelevated or otherwise abnormal blood glucose levels to evaluate if thesubject is at risk for developing diabetes, and administering oralanti-CD3 antibody if the subject is determined to be at risk. Subjectsat risk for diabetes include subjects with a familial history of type Idiabetes, as offspring and siblings of subjects with type 1 diabetesmellitus are at increased risk for the disease. Others who may beconsidered at risk for type 1 diabetes include younger individuals ifthey are obese (>120% desirable body weight or a body mass index=27),have a first-degree relative with diabetes, are members of a high-riskethnic population (African American, Hispanic American, Native American,Asian American), have delivered a baby weighing more than 9 lb, havepreviously had gestational diabetes mellitus (GDM; permanent diabeteswill develop in approximately 50% of subjects within 10 years of GDM),are hypertensive (blood pressure=140/90 mm Hg), have atherogenicdyslipidemia (high-density lipoprotein [HDL] cholesterol levels=35 mg/dlor triglyceride levels=250 mg/dl) or had impaired glucose tolerance(IGT) or impaired fasting glucose (IFG) on previous testing. Individualshaving or at risk of developing diabetes caused by chronic pancreatitis,pancreatectomy, or carcinoma of the pancreas can also be treated usingthe methods described herein.

A subject who has been determined to be at risk for diabetes can then betreated prophylactically with oral or mucosal administration of ananti-CD3 antibody to prevent or delay the development of diabetes, orreduce the severity of the diabetes, e.g., reduce the subject'sdependence on injected insulin; other measures can be used concurrentlyto help prevent diabetes, e.g., modification in diet or exercise,administration of oral anti-diabetics, or other methods known in theart.

The invention also includes methods of treating a subject havingdiabetes, comprising orally or mucosally administering a therapeuticallyeffective amount of an anti-CD3 antibody. A diagnosis of type 1 diabetesmellitus can be made, e.g., on the basis of symptom history confirmed bya blood or plasma glucose level greater than 200 mg/dl, with thepresence of glucosuria and/or ketonuria. The classic symptoms ofdiabetes are polyuria, polydipsia, weight loss with normal or evenincreased food intake, fatigue, and blurred vision, commonly present 4to 12 weeks before the symptoms are noticed. Before clinical onset oftype 1 diabetes mellitus, diagnosis may be possible with serologicmethods, e.g., complemented by beta cell function tests.

A therapeutically effective amount of an orally or mucosallyadministered anti-CD3 antibody can be an amount sufficient to produceone or more of the following: (1) decreasing plasma glucose levels andurine glucose excretion to eliminate polyuria, polydipsia, polyphagia,caloric loss, and adverse effects such as blurred vision from lensswelling and susceptibility to infection, particularly vaginitis inwomen, (2) abolishing ketosis, (3) inducing positive nitrogen balance torestore lean body mass and physical capability and to maintain normalgrowth, development, and life functioning, (4) preventing or greatlyminimizing the late complications of diabetes, i.e., retinopathy withpotential loss of vision, nephropathy leading to end stage renal disease(ESRD), and neuropathy with risk of foot ulcers, amputation, Charcotjoints, sexual dysfunction, potentially disabling dysfunction of thestomach, bowel, and bladder, atherosclerotic cardiovascular, peripheralvascular, and cerebrovascular disease. The current American DiabetesAssociation standards of care include (1) maintaining preprandialcapillary whole blood glucose levels at 80 to 120 mg/dl, bedtime bloodglucose levels at 100 to 140 mg/dl, and postprandial peak blood glucoselevels at less than 180 mg/dl, and (2) maintaining an HbA1c of less than7.0% (relative to a nondiabetic DCCT range of approximately 4.0% to6.0%).

The oral or mucosal anti-CD3 antibody can administered alone or incombination with a standard diabetes therapy, e.g., including but notlimited to the administration of one or more agents useful in thetreatment of diabetes, e.g., insulin, sulfonylureas (e.g., meglitinidesand nateglinides), biguanides, thiazolidinediones, and alpha-glucosidaseinhibitors, inter alia, as well as modification of diet or exerciseregime. Additional information about the diagnosis and treatment ofdiabetes can be found in the chapter on Diabetes Mellitus on theScientific American Medicine/WebMD website on the world wide web atsamed.com, the contents of which are incorporated herein by reference.

Treatment of Autoimmune Arthritis

Rheumatoid arthritis (RA) is the most common chronic inflammatoryarthritis and affects about 1% of adults; it is two to three times moreprevalent in women than in men. RA may begin as early as infancy, butonset typically occurs in the fifth or sixth decade. Diagnosis may bemade according to the American Rheumatism Association Criteria for theClassification of Rheumatoid Arthritis. A therapeutically effectiveamount will cause an improvement in one or more of the following: thenumber of inflamed joints, the extent of swelling, and the range ofjoint motion. Laboratory measurements (e.g., ESR and hematocrit value)and assessments of subjective features (e.g., pain and morningstiffness) can also be made. The invention includes methods of treatingautoimmune arthritis, e.g., RA, in a subject by administering to thesubject a therapeutically effective amount of an anti-CD3 antibody.

In some embodiments, the methods include the administration of a secondtherapeutic agent, e.g., for analgesia, to additionally controlinflammation, and/or to alter the natural history of the disease. Anumber of such agents are known in the art. For example, one or more ofNSAIDs, methotrexate, prednisone, TNF inhibitors, leflunomide, orsulfasalazine (with or without hydroxychloroquine) can be administered.Immunosuppressive agents such as azathioprine or cyclosporine can alsobe used.

Treatment or Prevention of Allograft Rejection

The methods described herein can also be used to treat or prevent graftrejection in a transplant recipient. For example, the methods can beused in a wide variety of tissue and organ transplant procedures, e.g.,the methods can be used to induce central tolerance in a recipient of agraft of cells, e.g., stem cells such as bone marrow and/or of a tissueor organ such as pancreatic islets, liver, kidney, heart, lung, skin,muscle, neuronal tissue, stomach, and intestines. Thus, the new methodscan be applied in treatments of diseases or conditions that entail cell,tissue or organ transplantation (e.g., liver transplantation to treathypercholesterolemia, transplantation of muscle cells to treat musculardystrophy, or transplantation of neuronal tissue to treat Huntington'sdisease or Parkinson's disease). In some embodiments, the methodsinclude administering to a subject in need of treatment: 1) an anti-CD3antibody, and 2) a donor organ or tissue, e.g., liver, kidney, heart,lung, skin, muscle, neuronal tissue, stomach and intestines.

In some embodiments, the transplanted tissue comprises pancreaticislets. Accordingly, the invention encompasses a method for treatingdiabetes by pancreatic islet cell transplantation. The method comprisesadministering to a subject in need of treatment: 1) an anti-CD3antibody; and 2) donor pancreatic islet cells. Typically, the anti-CD3antibody is administered to the recipient prior to and/or simultaneouslywith administration of the pancreatic islets.

In some embodiments, the recipient is then treated with a regimen ofimmune-suppressing drugs to prevent rejection of the tissue or organ.Standard regimens of immunosuppressive treatment are known. Tolerance todonor antigen can be evaluated by standard methods, e.g., by MLR assays.

In some embodiments, the donor is a living, viable human being, e.g., avolunteer donor, e.g., a relative of the recipient. In some embodiments,the donor is no longer living, or is brain dead, e.g., has no brain stemactivity. In some embodiments, the donor tissue or organ iscryopreserved. In some embodiments, the donor is one or more non-humanmammals, e.g., an inbred or transgenic pig, or a non-human primate.

EXAMPLES

The invention is further described in the following examples, which donot limit the scope of the invention described in the claims.

Materials and Methods

Anti-CD3 antibodies

Hybridoma cells producing the hamster 145-2C11 mAb (IgG anti-mouse CD3ε-chain) were purchased from ATCC. The hybridoma cells were grown in anIntegra flask in DMEM medium containing 10% Low Ig FCS; 10% NCTC-109; 1%non-essential amino acids; 1% sodium pyruvate; 1% L-glutamine; 1%antibiotic/antimycotic; 0.2% gentamycin. Flasks were split twice a weekand supernatants were collected and sent to Strategic Biosolutions(Newark, Del.) to concentration and purification.

Purified Hamster IgG (ICN Pharmaceuticals, Inc.) was used as an isotypecontrol (IC).

Feeding Anti-CD3 Antibody: SJL Mouse Model

Female SJL mice (a strain that exhibits experimental autoimmuneencephalomyelitis (EAE) following immunization with myelin proteolipidprotein (PLP)), at age 8 weeks were fed with anti-CD3 antibody (5, 50and 500 μg/mouse) in PBS for 5 consecutive days by gavage using an18-gauge stainless feeding needle. Spleens and mesenteric lymph nodes(MLN) were removed from the mice, typically 24-48 hours after the lastfeeding.

Two-Color Flow Cytometry

Two-color flow cytometry was performed as follows. 1×10⁶ cells isolatedfrom spleens and MLN removed 24 hours after the last feeding wereincubated in staining buffer (PBS with 4% BSA and 0.1% sodium azide) for5 min. The cells were then stained with phycoerythrin (PE)-labeledanti-mouse CD25 and fluorescein isothiocyanate (FITC) labeled anti-mouseCD4 for 30 min. The cells were washed twice and then fixed in PBS with1% formaldehyde. The analysis was performed on FACScan flow cytometerwith CellQuest software.

Proliferation of Spleen and MLN Cells

T cells from fed and non-fed mice were isolated from spleens andmesenteric lymph nodes (MLN) using mouse CD90 (Thy1.2) MACS MicroBeads.1×10⁵ T cells were cultured 1:1 with irradiated spleen cells fromnon-fed mice and stimulated with 0.5 μg/ml anti-CD3 in DMEM supplementedwith 10% heat-inactivated FBS, 2 mM L-glutamine, 100 U/ml penicillin,100 μg/ml streptomycin, and 50 μM 2-ME. Cultures were pulsed with [³H]Thymidine (1 μCi/well) 72 hours later and harvested 16 h later.

Induction and Evaluation of Clinical Course of EAE, an Animal Model ofMS, in PLP-Immunized Mice

Two days after the last feeding with the anti-CD3 antibodies,experimental allergic encephalomyelitis (EAE, an animal model ofmultiple sclerosis) was induced in the SJL mice by immunization in thefootpad with a fragment of myelin proteolipid protein (PLP) (139-151) 50μg/mouse emulsified 1:1 in complete Freunds adjuvant (CFA). Pertussistoxin (PT) 150 ng was given i.v. at the time of immunization and 48hours later. EAE was scored as follows: 0, no disease; 1, limp tail; 2,hind limb weakness; 3, hind limb paralysis; 4, hind and forelimbparalysis; 5, moribund.

Cytokine Assay

Spleen cells were harvested 41 days after immunization as describedabove. Cells were isolated and red blood cells were removed by lysis.Splenocytes were cultured at 1×10⁶ cells/well in 250 μl of Ex-Vivo 20serum-free medium with or without PLP antigen. Supernatants werecollected after 40 hours for IL-10 and 72 hours for TGF-β. The levels ofcytokines in the supernatants were determined by standard capture ELISA.Briefly, microtiter plates were coated with rat anti-mouse IL-10 mAb at1 μg/ml in 0.1 M carbonate buffer pH 8.2 at 4° C. overnight. Plates werewashed and blocked for 2 hours at room temperature (RT) with 10% BSAsolution. Standards and supernatant samples were added and incubatedovernight at 4° C. Plates were washed and biotinylated rat anti-mouseIL-10 mAb added for 1 hour at RT, followed by washing, and incubationfor 30 minutes at RT with peroxidase-labeled streptavidin.

For TGF-β quantification, plates were coated with 5 μg/ml polyclonalchicken anti-TGF-β for overnight incubation at 4° C. Mouse monoclonalanti-TGF-β was used as secondary antibody. Peroxidase-labeled goatanti-mouse IgG was used for detection. Bound cytokine was detected bythe addition of 2,2′-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid)acid (ABTS) and reading at OD 450 nm after color development.

Proliferation Assay: Splenocytes from PLP-Immunized Mice Splenocyteswere cultured at 5×10⁵ cells/well with or without PLP (139-151), for 72hours. [³H] Thymidine (1 μCi/well) was added for the last 12 hours ofculture. Cells were then harvested and incorporation of Thymidine wasmeasured using an LKB Betaplate liquid scintillation counter.

Clinical Course of EAE, an Animal Model of MS, in PLP-Immunized NOD Mice

NOD female mice (a mouse model of Type I diabetes) at age of 8 weeks fedwith anti-CD3 antibody (0.5, 5 and 50 μg/mouse) in PBS for 5 consecutivedays. Two days after the last feeding, mice were immunized in thefootpad with PLP (48-70) 100 μg/mouse emulsified 1:1 in CFA. Pertussistoxin (PT) 150 ng was given i.v. at the time of immunization and 48hours later. EAE was scored as described above. Spleen cells wereharvested 10 days after immunization. Spleen and MLN cells were isolatedand cytokine and proliferation assays were performed as described above,with or without stimulation in vitro with PLP 48-70 (1, 10 and 100μg/ml).

OVA TCR Tg Mice

OVA TCR Tg mice on the BALB/c background, clone DO11.10, were also used;DO11.10 mice, and CD4+ T cells derived from them, express a transgenic Tcell receptor (TCR) specific for a 17-amino acid peptide (323-339)derived from ovalbumin (OVA). OVA Tg mice at 8 weeks of age were fed for5 consecutive days with Isotype control or anti-CD3 antibody (0.5, 5, or50 μg; or, in some experiments, 50, 200 and 500 μg/mouse) in PBS.Twenty-four hours after the last feeding, spleens and lymph nodes wereremoved from the mice. Cytokines and proliferation assays were performedas described above, with or without stimulation in vitro with OVA(10,100 and 1000 μg/ml).

Example 1 Clinical Course of EAE in SJL Mice

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the clinical course of experimentalautoimmune encephalomyelitis (EAE) in SJL mice, a strain of micesusceptible to EAE.

Briefly, SJL mice were fed 5, 50 or 500 μg anti-CD3 antibody for 5 days.Forty-eight hours after the last anti-CD3 antibody feeding, EAE wasinduced by immunizing the mice with 50:g PLP (139-151) emulsified withCFA. EAE was scored as follows: 0, no disease; 1, limp tail; 2, hindlimb weakness; 3, hind limb paralysis; 4, hind and forelimb paralysis;5, moribund. The results are shown in FIG. 1. Interestingly, a reversedose-response was seen, with the best protection resulting from feeding5:g of anti-CD3 antibody.

Feeding with 5:g anti-CD3 antibody delayed the onset, and reduced theseverity, of the symptoms of EAE by six days as compared to control (day13±4, post immunization, in the control group compared with day 19±1.6in the 5:g fed group; p=0.04) and decreased maximal disease score from2.95±0.6 in the control group to 1.1±0.5 in the fed group (p=0.001). Onday 24 post immunization, all the animals in the 5:g fed group fullyrecovered, while in the control, unfed group the average disease scorewas 2.65±0.22 (p<0.001). No significant differences in the onset ofdisease or the maximal disease score were found in the groups fed 50:gor 500:g anti-CD3 antibody as compared to the control group. However,the mice that were fed with 50:g anti-CD3 reached the peak of thedisease on day 14, and then started to recover. On day 31, the averagedisease score in this group was 0.3±0.27 as compared to 2.2±0.7 in thecontrol group (p<0.001).

These results demonstrate that feeding with low doses of oral anti-CD3antibody can delay and reverse the induction of EAE.

Example 2 Proliferation of Spleen Cells from SJL Mice Immunized with PLP

Proliferation of T cells can be used as a good indicator of the activityof immune regulatory mechanisms; decreased proliferation in response tostimulation has been linked to antigen tolerance and increased levels ofanergic, regulatory cells, which can suppress proliferation of other,inflammatory T cells. The study described in this example examined theeffect of orally administered anti-CD3 antibody on the on theproliferation of spleen cells following induction of EAE in SJL mice.

SJL mice were fed 5, 50 or 500 μg anti-CD3 antibody for 5 days asdescribed above. 48 hours after the last feeding, mice were immunizedwith PLP (139-151) 50:g emulsified with CFA. On day 41 afterimmunization, spleen cells were prepared and stimulated in vitro with 1,10 or 100 μg/ml PLP for 72 hours. [³H] thymidine (1 μCi/well) was addedfor the last 12 h of culture. Cells were then harvested as describedabove and incorporation of thymidine was measured. Results are shown inFIG. 2; splenocytes isolated from mice fed 500:g of anti-CD3 antibodyshowed the least proliferation in response to immunization with PLP;those splenocytes from mice fed 5:g proliferated more, but less thanthose from mice fed 50:g, which proliferated similarly to unfed mice,illustrating a unique dose-responsiveness for this phenomenon.

The effects seen at the 5:g dose were confirmed in additionalexperiments. Briefly, SJL mice were fed 5 μg anti-CD3 antibody for 5days. 48 hours after the last feeding mice were immunized with PLP(139-151) 50:g emulsified with CFA. On day 41 after immunization, spleencells were prepared and stimulated in vitro with PLP 1, 10 and 100 μg/mlfor 72 hours. [³H] Thymidine (1 μCi/well) was added for the last 12hours of culture. Cells were then harvested and incorporation ofthymidine was measured. Results are shown in FIG. 3. Again, a dose of5:g anti-CD3 antibody was shown to be effective in reducing splenocyteproliferation in response to challenge with PLP. This result is evidencethat the oral administration of anti-CD3 antibodies increases regulationof the immune system, thus decreasing disease-inducing immune responsein PLP-immunized SJL mice.

Example 3 CD4+/CD25+ T Cell Response in MLNs Isolated from SJL MiceImmunized with PLP

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on levels of CD4+/CD25+ T cells, whichare thought to participate in the mucosal immune response and may serveto actively suppress antigen-specific responses, and Latency AssociatedPeptide (LAP)+ cells, associated with the precursor of TGF-β, inmesenteric lymph nodes (MLN), which are associated with the mucosalimmune system, in PLP-immunized SJL mice.

Briefly, SJL mice were fed 5 μg/ml anti-CD3 antibody or Isotype control(IC) for 5 days as described above. On day 6, lymphocytes from MLN from3 mice in each group were pooled, prepared and stained for CD4 and CD25or LAP, and analyzed by flow cytometry as described above.

The results for the CD4+/CD25+ cells, shown in FIG. 4, are as follows:Non fed: 11.9%; fed IC: 9.83%; fed aCD3− 5: 23.76%. Thus, MLNs isolatedfrom mice that were not fed anti-CD3 (non fed), or fed anisotype-matched control (fed IC), had similar levels of CD4+/CD25+ cells(about 10-12%), while MLN from mice fed 5:g anti-CD3 had increasedlevels of CD4+/CD25+ cells (about 24%).

In some instances there was an increase of CD4+LAP+ cells in the spleenand MLN after feeding anti-CD3; in the spleen, there was an increasefrom 5.5% to 7.9%; in the MLN, from 2.0% to 3.2%; and in the Peyer'spatches, CD4+LAP+ cells increased from 4% to 5.2%. These results werestatistically significant.

These results provide evidence that the decreased immune responseassociated with the oral administration of anti-CD3 antibodies isassociated with increased numbers of CD4+/CD25+ and CD4+LAP+ T cells inthe MLN, which demonstrates specific activation of T cells in the MLNafter oral administration of anti-CD3.

Example 4 T Cell Proliferation in SJL Mice

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on T cell proliferation in non-immunizedSJL mice.

T cells from fed and non-fed SJL mice were isolated from spleen (FIG.5A) and MLN (5B) using mouse CD90 (Thy1.2) MACS MicroBeads. 1×10⁵ Tcells were cultured 1:1 with irradiated spleen cells from non-fed miceand stimulated with 0.5 μg/ml anti-CD3 in DMEM supplemented with 10%heat-inactivated FBS, 2 mM L-glutamine, 100 U/ml penicillin, 100 μg/mlstreptomycin, and 50 μM 2-ME. Cultures were pulsed with [³H] thymidine(1 μCi/well) 72 hours later, and harvested 16 hours later. The results,shown in FIGS. 5A and B, indicate that spleen and MLN from mice fed with5:g/ml anti-CD3 antibody had reduced T cell proliferation as compared tocontrol. Proliferation of T cells in non-fed mice was set as 100%.Proliferation of T cells isolated from the spleens of mice fed anti-CD3antibody was 25%±10 versus non-fed controls (p<0.01; FIG. 5A);proliferation of T cells isolated from the MLN of mice fed anti-CD3antibody was 7.5%±4 versus non-fed controls (p<0.01; FIG. 5B).(Significance determined using the two-tailed student's t test)

These results indicate that the anti-inflammatory activity of orallyadministered anti-CD3 activity is associated with decreased T cellproliferative responses in the MLN and the spleen of non-immunized SJLmice.

Example 5 Comparison Clinical Course of EAE in NOD Mice

The study described in this example examined the effect of oraladministration of low doses of anti-CD3 antibodies on the induction andsymptoms of EAE in NOD mice, a model of autoimmune diabetes. NOD miceare susceptible to experimental autoimmune encephalomyelitis (EAE)induced by the proteolipoprotein (PLP) epitope 56-70, and thus provideanother animal model of MS.

Briefly, as described above, the mice were fed 0.5, 5 or 50 μg anti-CD3antibody or IC for 5 days. 48 hours after the last feeding, mice wereimmunized with 100:g PLP (48-70) emulsified with CFA. EAE was scored asfollows: 0, no disease; 1, limp tail; 2, hind limb weakness; 3, hindlimb paralysis; 4, hind and forelimb paralysis; 5, moribund. The resultsare shown in FIG. 6. The statistical analysis was performed using meancumulative score±SEM (Non-fed: 8.7±1.4; fed 0.5:g:0.8±0.4; fed5:g:10.9±4.2; fed 50:g:6.7±2.9; fed IC: 13.2±5). The results show thatin PLP-immunized NOD mice fed with 5:g anti-CD3, there is a significantinhibition of EAE as compared to the non-fed group (p=0.0006) and to theIC group (p=0.005). Further, the effect of orally administered CD3 isnot specific to a single animal model (see Example 1, indicatingtherapeutic efficacy in SJL mice), strain or peptide, and so is likelyto work in humans.

Example 6 Proliferation of Spleen Cells from NOD Mice Immunized with PLP

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on T cell proliferation in NOD miceimmunized with PLP.

NOD mice were fed 0.5, 5 or 50 μg anti-CD3 antibody or IC for 5 days.Forty-eight hours after the last feeding, mice were immunized with 100μg PLP (48-70) emulsified with CFA. On day 10 after immunization, spleencells were prepared and stimulated in vitro with 1, 10 or 100 μg/ml PLPfor 72 hours. [³H] thymidine (1 μCi/well) was added for the last 12hours of culture. Cells were then harvested. The results, shown in FIGS.7 and 8, demonstrate that oral administration of low doses of anti-CD3antibody results in decreased T cell proliferation. Proliferation ofspleen cells from NOD fed 5 μg anti-CD3 was 26198±696 cpm, which wassignificantly lower (p<0.01) when compared to mice that were fed with IC(81000±2009 cpm).

This result is evidence that the oral administration of anti-CD3antibodies decreases disease-inducing immune responses in PLP-immunizedNOD mice.

Example 7 Cytokine Production in Spleen Cells from NOD Mice Immunizedwith PLP

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the production of the cytokine IL-10in spleen cells from NOD mice exhibiting EAE after immunization withPLP.

NOD mice were fed 0.5, 5 or 50 μg anti-CD3 antibody or IC for 5 days. 48hours after the last feeding, mice were immunized with PLP (48-70) 100μg emulsified with CFA. On day 10 after immunization, spleen cells wereprepared and stimulated in vitro with 1 μg/ml anti-CD3 antibody.Supernatants were collected after 40 hours and IL-10 was measured byELISA. The results are shown in FIG. 9. Level of IL-10 secreted by thedifferent groups: non-fed: 1422±551; fed 0.5:g:4489±566; fed5:g:2726±661; fed 50:g:1438±620; fed IC: 3005±764. The level of IL-10from mice that were fed with 0.5 μg anti-CD3 was significantly highercompared to the non fed mice p=0.01. This illustrates that oraladministration of low doses of anti-CD3 antibody results in increasedIL-10 production as compared to control. This provides evidence that thetherapeutic activity of orally administered anti-CD3 antibody may bemediated at least in part by increased levels of IL-10, which is knownas regulatory Th2 cytokine involved in the reversal of EAE.

Example 8 Cytokine Production in Spleen Cells from OVA TCR TransgenicMice

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the production of theanti-inflammatory cytokines IL-10 and TGF-β in spleen cells fromovalbumin (OVA)-specific T-cell receptor transgenic (“OVA TCR Tg” or“OVA Tg”) mice.

OVA TCR Tg mice were fed 5 consecutive days with isotype control (IC) oranti-CD3 antibody (50, 200, or 500 μg; the higher doses required foreffectiveness in these mice may be due to their transgenic nature).Twenty-four hours after the last feeding, spleens were removed from themice. Spleen cells were prepared and stimulated in vitro with 1000 μg/mlOVA. Supernatants were collected after 40 hours for IL-10 measurements(FIG. 10A) and after 72 hours for TGF-β measurements (FIG. 10B).Cytokine levels were measured by ELISA. The IL-10 results, as shown inFIG. 10A, were as follows (IL-10, pg/ml): control: 283±56; fed50:g:923±99; fed 200:g:750±89; fed 500:g:289±25. The level of IL-10 inthe mice that were fed 50 and 200 was significantly higher (p<0.01;p=0.01, respectively). The levels of TGF-β, as shown in FIG. 10B, wereas follows (TGF-β, pg/ml): control 225±40; fed 50:g:373±25; fed200:g:460±85; fed 500:g:640±100. This illustrates that the level ofTGF-β in the mice that were fed 50, 200 and 500 μg of anti-CD3 antibodywas significantly higher (p=0.05; p<0.01, p<0.01, respectively). Theseresults demonstrate that oral administration of low doses (50:g) ofanti-CD3 antibody result in increased IL-10 production as compared tocontrol, and higher doses (500:g) of anti-CD3 antibody result insignificantly increased TGF-β production. Thus, the higher doses oforally administered anti-CD3 antibody may be affecting a differentpopulation of cells, possibly Th3 cells associated with TGF-β productionas opposed to Th2 cells associated with IL-10 production.

Example 9 Proliferation of Spleen Cells from OVA Tg Mice

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the proliferation of spleen cells fromovalbumin (OVA)-specific T-cell receptor transgenic (“OVA TCR Tg” or“OVA Tg”) mice.

OVA Tg mice were fed for 5 consecutive days with isotype control oranti-CD3 antibody (50, 200, and 500 μg). Twenty-four hours after thelast feeding, spleens were removed from the mice. Spleen cells wereprepared, and stimulated in vitro with 10, 100 or 1000 μg/ml OVA for 72hours (control cells were unstimulated). [³H] Thymidine (1 μCi/well) wasadded for the last 12 hours of culture. Cells were then harvested. Theresults are shown in FIG. 11. The average proliferation of the differentgroups, expressed as (CPM)±STDEV, was as follows: non-fed: 180100±1000;fed 50:g:133176±5200; fed 200:g:158951±20000; fed 500:g:157200±30000.The proliferation of cells from mice that were fed 50:g anti-CD3antibody was significantly reduced compared to the non-fed group(p<0.05). Thus, in non-immunized (e.g., normal) Tg mice the oraladministration of higher doses of anti-CD3 antibody appears to havelittle effect on spleen cell proliferation.

Example 10 Allogeneic Cardiac Transplantation

The study described in this example examined the effect of oraltreatment with anti-CD3 antibody on survival after allogeneic cardiactransplantation.

Briefly, a dose of 5 μg of anti-CD3 antibody (clone 145-2C11) in 200:1volume was administered to C57BL/6 mice by oral gavage each daybeginning on day −5 and continuing until day+10 post transplantation(for a total of 16 administrations); day 0 being the day oftransplantation. The mice received heart transplants from BALB/c donormice, and were monitored for cessation of heartbeat to determine the dayof rejection.

Cardiac transplants in control mice receiving no anti-CD3 treatmentsurvived an average of 8.4±1.0 days (n=11); cardiac transplants in micereceiving the anti-CD3 treatment survived an average of 16.2±5.8 days(n=5; p=0.0004 by Logrank test). Thus, oral administration of anti-CD3antibody can successfully delay or prevent allograft rejection.

Example 11 Chronic Model of EAE

The study described in this example examined the effect of oraladministration of low doses of anti-CD3 antibodies on the induction andsymptoms of EAE in NOD mice, a model of autoimmune diabetes. Fifteenweek old NOD mice, when immunized with the MOG (35-55) peptide, are amodel for chronic EAE/MS.

14 week old female NOD mice were fed 0.5, 5 or 50:g anti-CD3 antibody orIC for 5 days. Forty-eight hours after the last feeding, mice wereimmunized with the encephalitogenic myelin oligodendrocyte glycoprotein(MOG) (35-55) peptide, 150:g emulsified with CFA, and EAE was scored asdescribed. The statistical analysis was performed using Mean cumulativescore±SEM. As is illustrated in FIG. 12, EAE scores were as follows atday 83: Non-fed: 39±14.58; fed 0.5:g:33.78±6.79; fed 5:g:8.75±14; fed50:g:38.5±16.8; fed IC: 32.9±20.54. Thus, mice that were fed with 5:ganti-CD3 antibody show significant inhibition of EAE as compared to thenon-fed group (p=0.001). This result indicates that the effect of orallyadministered is not limited to a specific animal model (consider withExamples 1 and 5). Further, the results of this study indicate thatorally administered anti-CD3 antibody has therapeutic value in a chronicmodel of MS, as well as the relapsing/remitting models as illustrated inExamples 1 and 5, which use different antigenic peptide to induce EAE.

Example 12 Proliferation of Spleen and Popliteal Lymph Node (PLN) Cells

The study described in this example examined the effect of oraladministration of low doses of anti-CD3 antibodies on the proliferationof spleen and Popliteal Lymph Node (PLN) cells. The PLNs are locatednear the legs and stomach, and are considered non-specific lymph nodes.

SJL mice were fed 0.5, 5 or 50 μg anti-CD3 antibody for 5 days.Forty-eight hours after the last feeding, mice were immunized with PLP(139-151) 50 μg emulsified with CFA. On day 10 after immunization,spleen and PLN cells were prepared and stimulated in vitro with anti-CD3antibody 2 μg/ml (FIG. 13A) and PLP 100 μg/ml (FIG. 13B) respectively,for 72 hours. [³H] Thymidine (1 μCi/well) was added for the last 12hours of culture. Cells were then harvested and thymidine uptakemeasured as described.

The proliferation of PLN cells from mice that were fed with 0.5:ganti-CD3 antibody (38501±6160) and PLN cells from mice that were fed 5:ganti-CD3 antibody (28900±4578) was significantly reduced as compared toPLN cells from the non fed mice (p=0.03 and p=0.007, respectively).These results indicate that oral administration of anti-CD3 antibody isable to effect a decrease in the inflammatory response outside of, aswell as within, the mucosal immune system, as expected for toleranceinduced in the gut, which results in systemic tolerance.

Example 13 Cytokine Production in PLN Cells from SJL Mice Immunized withPLP

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the production of the cytokine IL-10in PLN cells from SJL mice exhibiting EAE after immunization with PLP.

SJL mice were fed 0.5, 5 or 50 μg anti-CD3 antibody or IC for 5 days.Forty-eight hours after the last feeding, mice were immunized with PLP(139-151) 50:g emulsified with CFA. On day 10 after immunization, PLNcells were prepared and stimulated in vitro with anti-CD3 antibody 1μg/ml. Supernatant was collected after 40 hours and IL-10 was measuredby ELISA. Results are shown in FIG. 14. PLN cells from mice that werefed 5 μg aCD3 secrete more IL-10 after stimulation in vitro withanti-CD3 antibody as compared to the non-fed and the IC groups (p=0.02).This provides further evidence that the therapeutic activity of orallyadministered anti-CD3 antibody may be mediated at least in part byincreased levels of IL-10.

Example 14 Cytokine Production in Spleen Cells from SJL Mice Immunizedwith PLP

The study described in this example examined the effect of orallyadministered anti-CD3 antibody on the production of the cytokine IL-10in spleen cells from SJL mice exhibiting EAE after immunization withPLP.

SJL mice were fed 0.5, 5 or 50 μg anti-CD3 antibody or IC for 5 days.Forty-eight hours after the last feeding, mice were immunized with PLP(139-151) 50:g emulsified with CFA. On day 10 after immunization, spleencells were prepared and stimulated in vitro with anti-CD3 antibody 1μg/ml. Supernatants were collected after 24 and 40 hours (for IL-2 andIL-10 respectively) and cytokine levels were measured by ELISA.

The results demonstrate that cells from fed mice secrete less IL-2 (FIG.15A) and more IL-10 (FIG. 15B) as compared to IC and non-fed mice. Thisprovides additional evidence that the therapeutic activity of orallyadministered anti-CD3 antibody is mediated at least in part by increasedlevels of IL-10; the decreased levels of IL-2 correlate with decreasedproliferation and further support the theory that the mechanism involvesincreased immune regulation and an increased anti-inflammatory response.

Example 15 Adoptive Transfer of Tolerance

The study described in this example examined the effect of injectingrecipient mice with T cells isolated from the spleen or mesenteric lymphnodes (MLN) of mice fed with orally administered anti-CD3.

SJL mice were fed 5 μg anti-CD3 antibody for 5 days. Twenty-four hoursor seven days after the last feeding T cells were isolated from thespleen or mesenteric lymph nodes (MLN). T cells were purified from thespleen preparation using mouse CD90 MACS MicroBeads. 20×10⁶ T cells fromthe MLN, or 40×10⁶ T cells from the spleen, were transferred byintravenous infusion to recipient SJL mice, at the same time the micewere immunized with PLP peptide (139-151) as described herein. EAE wasscored as described herein.

The results are as follows, expressed as mean cumulative score±STD. MLNfrom fed mice transferred 24 hours after the last feeding: 4±3.88(p=0.012); MLN from non-fed mice: 20.1±1.2; spleen T cells from fed micetransferred 1 week after the last feeding: 4.93±3.07 (p=0.027); Spleen Tcells from non fed mice: 10.42±2.2. These results demonstrate that oralanti-CD3 antibody induces regulatory T cells that can adoptivelytransfer protection against EAE in vivo; this protection can betransferred from a mouse fed with anti-CD3 antibody to a naïve recipientmouse.

Example 16 The Effect of Administration of Anti-CD3 Antibody Before orafter Induction of EAE

The study described in this example examined the effect on the clinicalcourse of EAE of the timing of the oral administration of anti-CD3antibody, i.e., before and after induction of EAE by immunization of SJLmice with a PLP-derived peptide.

SJL mice were fed 0.5, 5 or 50 μg anti-CD3 antibody or IC for 5 daysbefore immunization (days −7 to −2) and at the peak of the disease (days13-17 post-immunization). Forty-eight hours after the last feeding, micewere immunized with PLP (139-151) 50:g emulsified with CFA. EAE wasscored as follows: 0, no disease; 1, limp tail; 2, hind limb weakness;3, hind limb paralysis; 4, hind and forelimb paralysis; 5, moribund. Thestatistical analysis was performed using Mean cumulative score±SEM.

The results are illustrated in FIGS. 17A-C. All the fed mice that werefed before induction of EAE shown significant inhibition of disease ascompared to the IC group (fed 0.5 μg anti-CD3 p=0.055; fed 5 μg anti-CD3p=0.016; fed 50 μg anti-CD3 p=0.03). The mice that were fed with 5 μganti-CD3 at the peak of the disease (days 13-17) showed significantinhibition of the disease as compared to the group fed IC beforeimmunization with the peptide (days −7 to −2) and at the peak (days13-17; FIG. 17B; p=0.03; p=0.016 respectively) These results indicatethat the administration of oral anti-CD3 antibody after the onset of EAEis also effective at certain doses.

Example 17 The Effect of Oral Administration of Anti-CD3 Antibody onDevelopment of Diabetes

The study described in this example examined the effect of feedingnewborn NOD mice with 0.5 or 5:g anti-CD3 antibodies (aCD3), orisotype-matched control (IC) on the subsequent development ofspontaneous diabetes.

NOD mice were fed starting 24 hours after birth, as follows:

TABLE 1 NOD mice fed as newborns First feeding (5 times, starting 24 hafter At 3 Weeks of Age Group (n) birth and once a week) (once a week) 1(11) 0.05 microgram/mouse aCD3 0.5 microgram/mouse aCD3 2 (17) 0.5microgram/mouse aCD3 5 microgram/mouse aCD3 3 (11) 0.05 microgram/mouseIC 0.5 microgram/mouse IC

Diabetes was assessed by colorimetric strips to monitor glycosuria. Theresults of this study, illustrated in FIG. 18, demonstrate that not onlydid oral administration of anti-CD3 antibody apparently result indelayed onset, the absolute occurrence of diabetes was substantiallyreduced.

The effect on development of spontaneous diabetes of feeding NOD micewith anti CD3 0.5:g/feeding or 5:g/feeding was evaluated at weeks 12 to33. Both treatments proved to be significantly better than the ICcontrol at preventing the development of diabetes; statistical analysiswas performed using the student's t test, with unpaired and two tailedp-value. Oral administration with 0.5:g anti CD3 has a p-value of0.0002, and feeding with 5:g anti CD3 has a p-value of 0.0001 allcompared to the IC (0.5) control group.

Example 18 The Effect of Oral and Nasal Administration ofAntigen-Binding Fragments of Anti-CD3 Antibody on Clinical Course of EAE

The study described in this example examined the effect of orally ornasally administering antigen-binding fragments of anti-CD3 antibodieson the subsequent development of experimental autoimmuneencephalomyelitis.

Briefly, female SJL mice that were 6-8 weeks old were either fed200:1/mouse every day or nasally administered 10:1/mouse every other dayof F(ab)′2 derived from an anti-CD3 antibody or Isotype-matched Control(IC; hamster IgG), for 5 days, starting a week before induction of EAE.The feeding schedule is shown in Table 2.

TABLE 2 Feeding Schedule d-6 d-5 d-4 d-3 d-2 Control PBS + + + + + OralIC; 5 μg + + + + + Oral IC; 50 μg + + + + + Oral F(ab)′2 αCD3; 5μg + + + + + Oral F(ab)′2 αCD3; 50 μg + + + + + Nasal F(ab)′2 αCD3; 0.1μg + + + Nasal F(ab)′2 αCD3; 0.5 μg + + +

EAE was induced by immunizing the mice on day 0 with PLP139-151,75:g/mouse; MTb, 400:g/mouse; Emulsion, 200:1/mouse; (PBS+Peptide),mixed with an equal volume of Complete Freund's Adjuvant; and PertissisToxin (PT), 150 ng/mouse. PT was administered again on day+2, ip.

The results are shown in FIG. 19, and demonstrate that orallyadministered (5:g) and nasally administered (0.5:g) F(ab′)₂ bothsubstantially reduced the overall severity and delayed time of onset ofEAE. The effects were statistically significant (p<0.05); Oral IC vs.Oral Fab p=0.002; Nasal Fab (0.5) vs. Oral IC=0.005; Nasal Fab (0.5) vs.PBS=0.03; Nasal Fab (0.5) vs. PBS vs. Oral IC p=0.03. These resultsindicate that orally and nasally administered antigen-binding fragmentsof the anti-CD3 antibodies are effective in treating EAE, anexperimental model of multiple sclerosis.

Example 19 Effect of Orally Administered Anti-CD3 F(Ab′)₂ inStreptozotocin-Induced Model of Diabetes

To determine the effect of orally administered anti-CD3 F(ab′)2 ondiabetes, wild type normal AKR mice (Jackson Laboratory, Bar Harbor,Me.) were treated with streptozotocin (STZ), which has been shown toinduce diabetes in these mice. Parenterally administered anti-CD3antibody has been shown to be effective in these mice, see Herold etal., Diabetes. 1992 March; 41(3):385-91.

Briefly, AKR mice 6-8 weeks of age were placed into one of four groupsas follows:

-   -   Group 1. Non-treated (n=4);    -   2. Oral PBS+STZ i.p. (40 mg/kg) (n=12), administered once a day        for 5 days for 5 total doses;    -   3. Oral IC (50 μg/0.2 ml/mice)+STZ i.p. (40 mg/kg) (n=12),        administered once a day for 5 days for 5 total doses; and    -   4. Oral Anti-CD3 F(ab′)2 (50 μg/0.2 ml/mice)+STZ i.p. (40 mg/kg)        (n=12), administered once a day for 5 days for 5 total doses.

Glucose tolerance tests were administered by measurement of bloodglucose at 30 minutes after i.p. injection of 20% glucose/mouse on days7, 14, 21, and 28. Mice with blood glucose readings >250 mg/dl werediagnosed as diabetes.

The results are shown in FIGS. 20 and 21. Orally administered anti-CD3F(ab′)₂ was effective in reducing the incidence of STZ-induced diabetesin these mice, and also in delaying the onset of diabetes.

Example 20 Effect of Mucosal Administration of Anti-CD3 Antibody onCollagen Induced Arthritis (CIA)

To evaluate the effect of orally administered anti-CD3 antibodies onautoimmune/rheumatoid arthritis (RA), a collagen induced animal modelwas used. This animal model of arthritis is an autoimmune model that inmany ways resembles RA, as described in Myers et al., Life Sci.61(19):1861-78 (1997). DBA/1 male mice (Jackson Laboratory, Bar Harbor,Me.) at 6-8 weeks of age were used in this study.

The mice were treated with anti-CD3 F(ab′)₂ (Bio-express), or Isotypecontrol (IC) F(ab′)₂ (JAX Immunoresearch, Bar Harbor, Me.). Mice werefed (5:g/feeding, 5 times on consecutive days) or nasally treated(0.5:g/treatment, 3 times every other day) with anti CD3 antibodies(clone 2CII) or F(ab′)₂ preparation, PBS, isotype control antibody orF(ab′)₂ isotype control (IC). Each control or treatment group contained10 mice.

Two days after the last treatment, the mice were immunized intradermallyin 5 sites at the base of the tail with 100:g chicken collagen type IIemulsified with Complete Freund's Adjuvant (Difco Labs) containing 50:gMycobacterium Tuberculosis (H37RA).

Three weeks later the mice were boosted with a 100:g of soluble collagentype II by intraperitoneal (I.P.) injection.

Starting one week after the booster, the mice were observed twice a weekfor the presence of distal joint swelling and erythema. Typically, micestart to show the first symptoms one week after the booster and diseaseseverity continues to exacerbate for more than 80 days. Each limb wasscored on a scale of 0 to 4, as follows:

-   -   0—absence of arthritis    -   1—erythema and mild swelling of the tarsus    -   2—moderate erythema and swelling of the tarsus and ankles    -   3—severe swelling of the tarsus and ankles    -   4—ankylosis and bony deformity

The Maximum Arthritic Index (MAI) for each mouse is obtained by summingthe highest score recorded for each limb (0=no disease, 16 being thehighest possible score). The MAI for each group was calculated accordingto the Mean MAI.

The results are shown in FIGS. 22A-C. Mice fed or nasally treated withanti-CD3 F(ab′)₂ prior to CIA induction had a significantly lowerdisease score as compared to either control (PBS treated mice) orisotype control treated mice (FIGS. 22A and 22C). These results indicatethat the nasally administered anti CD3 F(ab′)₂ generated a betterresponse than the orally administered anti-CD3 F(ab′)₂ preparation(FIGS. 22A and 22C). Mice nasally treated with Anti-CD3 F(ab′)₂ scoredsignificantly lower (less arthritis) than mice treated with collagen(oral treatment with collagen), although both showed lower scores thancontrol treated mice (FIG. 22B).

These results demonstrate that nasally and orally administered anti-CD3F(ab′)₂ are effective in an in vivo model of autoimmune arthritis.

Example 21 LAP+ Cells in MLN and Peyer's Patch Increase after Feedingwith Oral Anti-CD3 Whole IgG

Latency Associated Peptide (LAP) is associated with the secretion offunctional TGFβ. LAP+ cells are regulatory, and secrete TGFβ (Oida etal., J. Immunol. 170(5):2516-22 (2003)). These cells have been shown tohave an immune regulatory effect in humans (Nakamura et al., J. Immunol.172(2):834-42 (2004)), and are important in suppression of inflammatorydisease (La Cava et al., J. Immunol. 173(5):3542-8 (2004); Ostroukhova,J. Clin. Invest. 114:28 (2004)). The experiments described in thisexample demonstrate the effect of oral anti-CD3 on LAP+ cells.

Mice were fed with 5 μg of anti-CD3 or isotype control Ab for 5consecutive days. 24 hours after the last feeding, freshly preparedcells were stained and analyzed by flow cytometry.

TABLE 3 Isotype PBS Control Anti-CD3 Spleen % CD3 among lymphocytes 42.6± 5.7 44.7 + 6.0 43.0 ± 6.5 % CD25+CD4+ cells 13.1 ± 1.6 12.6 ± 1.9 14.1± 2.3 among CD4+ cells % LAP+ cells  8.7 ± 1.1  8.3 ± 0.9  9.9 ± 1.5among CD3+ cells % LAP+ cells  4.7 ± 0.6  5.1 ± 0.8  6.3 ± 1.6**, #among CD4+ cells Mesenteric LN % CD3 among lymphocytes 76.2 ± 3.4 79.0 ±2.6 78.5 ± 3.3 % CD25+CD4+ cells 11.5 ± 1.7 10.6 ± 1.3 11.0 ± 2.0 amongCD4+ cells % LAP+ cells  3.0 ± 0.5  3.4 ± 0.5  5.2 ± 2.0**, ## amongCD3+ cells % LAP+ cells  2.0 ± 0.5  2.1 ± 0.4  3.4 ± 0.9**, ## amongCD4+ cells Peyer's Patch % CD3 among lymphocytes 39.3 ± 3.4 43.0 ± 6.439.6 ± 5.0 % CD25+CD4+ cells 14.0 ± 1.8 13.1 ± 2.1 15.4 ± 3.2 among CD4+cells % LAP+ cells  8.6 ± 1.0  8.8 ± 1.5 11.1 ± 2.4*, # among CD3+ cells% LAP+ cells  3.7 ± 0.7  3.4 ± 0.8  4.6 ± 1.4*, ## among CD4+ cells **p< 0.01 as compared with PBS-fed group. *p < 0.05 as compared withPBS-fed group. ## p < 0.01 as compared with isotype control-fed group. #p < 0.05 as compared with isotype control-fed group.

These results demonstrate that feeding anti-CD3 antibody increasesregulatory cells, which suppress disease. The increase in these LAP+cells can be used to measure the immunological effect of anti-CD3administration, thus, an increase in LAP+ cells in the bloodstream canbe used to detect the therapeutic effect of the oral or mucosaladministration of anti-CD3 antibody.

Example 22 Cytokine Production from LAP+ and LAP− T Cells Before andafter Administration of Oral Anti-CD3

To evaluate the effect of oral anti-CD3 on cytokine production, micewere fed with 5 μg of anti-CD3 or isotype control Ab for 5 consecutivedays. 24 hours after the last feeding, LAP+ and LAP− T cells wereprepared and stimulated with plate bound anti-CD3 (coated at 10 μg/ml).

The results, shown in FIGS. 23A-D, in combination with the resultsdiscussed in Example 21, demonstrate that administration of anti-CD3antibodies results in an increase in LAP+ cells, which results in anincrease in TGFβ and IL-10 secretion. Thus, feeding anti-CD3 antibodyincreases populations of disease-suppressing regulatory cells. Theincrease in these LAP+ cells, and the increase in TGFβ and IL-10production, can be used to measure the immunological effect of anti-CD3administration and thus to detect and evaluate the therapeutic effect ofthe oral or mucosal administration of anti-CD3 antibody.

Example 23 In Vitro Suppressive Activity of LAP+ Cells and OralAdministration of Anti-CD3 Antibody

To evaluate the effect on the in vitro suppressive activity of LAP+Cells after oral administration of anti-CD3 antibody, mice were fed with5 mg of anti-CD3 or isotype control Ab for 5 consecutive days. 24 hoursafter the last feeding, LAP+ T cells were prepared and their suppressiveactivity was examined in cultures of CD4+CD25-LAP− responder cellsstimulated with soluble anti-CD3 (1 mg/ml) plus T-depleted APC fromnaïve mice.

The results, shown in FIG. 24, illustrate that the in vitro suppressiveactivity of LAP+ cells was enhanced after the feeding.

Example 24 Effect of Recombinant LAP In Vitro Suppressive Activity ofLAP+ Cells

To evaluate the effect on the in vitro suppressive activity of LAP+cells, LAP+ T cells from fed mice were co-cultured with CD4+CD25-LAP−cells from naïve mice with or without 10 mg/ml of recombinant LAP. Theresults, shown in FIG. 25, demonstrate that the in vitro suppressiveactivity of LAP+ cells from fed mice was partially reversed byrecombinant LAP.

Example 25 Adoptive Transfer of T Cells from Mesenteric Lymph Nodes

To determine whether the protective effects of the administration oforal anti-CD3 can be adoptively transferred, donor SJL/J mice were fedwith 5 mg of anti-CD3 or isotype control Ab for 5 consecutive days.Their mesenteric lymph nodes were removed 48 hours after the lastfeeding, and purified T cells or LAP-depleted T cells were injectedintravenously to naïve SJ/J mice. Recipient mice were immunized with 50mg of PLP139-151 in CFA to induce EAE. The results, shown in FIG. 26,demonstrate that the effects of oral administration can be adoptivelytransferred by transplantation of LAP+ cells from fed mice.

Example 26 Neutralization of TGF-β Reversed the Disease Inhibition afterOral Administration of Anti-CD3

To evaluate a possible mechanism by which the disease inhibiting effectof oral anti-CD3 might be occurring, mice were fed with 5 mg of anti-CD3or isotype control Ab for 5 consecutive days and immunized with 50 mg ofPLP139-151 in CFA 48 hours after the last feeding to induce EAE. Incombination with the feeding, mice were injected 50 mg of neutralizinganti-TGF-β or isotype control Ab intraperitoneally on days −1, 1, 3, 5and 7. The results, shown in FIG. 27, demonstrate that neutralization ofTGF-β reversed the disease inhibition that results from oraladministration of anti-CD3.

OTHER EMBODIMENTS

It is to be understood that while the invention has been described inconjunction with the detailed description thereof, the foregoingdescription is intended to illustrate and not limit the scope of theinvention, which is defined by the scope of the appended claims. Forexample, other antibodies besides the anti-CD3 antibodies describedherein can be administered orally or by other mucosal routes tostimulate the mucosal immune system. For example, in addition toanti-CD3, other antibodies may be given orally or by other mucosalroutes to target specific mucosal T cells or immune cell populations inthe mucosal immune system, and generate regulatory cells or inducetolerance to treat autoimmune and other inflammatory disorders. Examplesinclude: a) antibodies against co-stimulatory molecules known to beinvolved in immune regulation such as CD2, ICOS, CD28, CTLA-4, and PD-1or their ligands; b) antibodies against molecules associated with NK-Tcells such as CD94, NK G2; c) antibodies against MHC molecules or theirrecognition structures such as CD4 and CD8; d) T cell differentiationmolecules as TIM molecules; and e) any antibodies or combination thereofthat either activate or promote tolerance. Other aspects, advantages,and modifications are within the scope of the following claims.

What is claimed is:
 1. A method of treating, preventing, or delaying theonset of an autoimmune disease in a subject, the method comprisingadministering to the subject an anti-CD3 antibody, wherein theadministering is oral or mucosal.